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

Las investigaciones realizadas en el marco del Grupo mixto dirigido Programa de Información y Comunicación Ciencia y Tecnología - ICST, apoyada por el CNRS, INRIA, y el horario de verano, bajo el paraguas de CEFIPRA. Los autores desean agradecer el apoyo de los estudiantes, específicamente Rahima Sidiboulenouar, Rishabh Sehgal, y Gorish Aggarwal, hacia el desarrollo de la configuración experimental.

Nota: La tubería de software HMI fue desarrollado en base a software de código abierto libremente disponible y off-the-shelf sensores de videojuegos bajo costo (detalles disponibles en: https://team.inria.fr/nphys4nrehab/software/ y https: //github.com/NeuroPhys4NeuroRehab/JoVE). Se proporciona la tubería de software HMI para la recogida de datos durante una tarea de alcance funcional modificada (mFRT) 21 en una plataforma de juegos basada en realidad virtual para la terapia de equilibrio visuomotor (VBT) ...

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Una herramienta de bajo costo clínicamente válida fácil de usar, para la terapia de movimiento y el equilibrio será un cambio de paradigma para la neurorrehabilitación en un entorno de bajos recursos. Es probable que tenga un alto impacto en la sociedad ya que los trastornos neurológicos tales como derrames cerebrales aumentarán drásticamente en el futuro debido al envejecimiento de la población mundial 2. Existe, por tanto, una necesidad apremiante de aprovechar los sistemas físicos cibernéticos, ...

Un episodio de disfunción neurológica causada por cerebral focal, la médula, o infarto de retina se denomina accidente cerebrovascular 1. El ictus es un problema de salud mundial y la cuarta causa principal de discapacidad en todo el mundo 1. En países como India y China, los dos países más poblados del mundo, la discapacidad neurológica debida a un accidente cerebrovascular ha sido catalogada como epidemia oculta 2. Una de las complicaciones médicas más comunes después de un derrame cerebral son las caídas con una incidencia de hasta un 73% en el primer año posterior al accidente cerebrovascular 3. La caída posterior al accidente cerebrovascular es multifactorial e incluye tanto los factores espinales y supraespinales como el equilibrio y la negligencia visuoespacial 4. Una revisión realizada por Geurts y sus colegas 5 identificados 1) afectada en múltiples direcciones de peso máxima mueva durante la bipedestación, 2) baja velocidad, 3) imprecisión direccional, y 4) las pequeñas amplitudes de las oscilaciones del peso plano frontal submáximos individuales y cíclicos como el equilibrio factores de ri caídask. La consecuente impacto en las actividades de la vida diaria puede ser importante ya que las obras anteriores han demostrado que el equilibrio se asocia con la capacidad ambulatoria y la independencia de la función motora gruesa 5, 6. Por otra parte, Geurts y sus colegas sugirieron que la integración 5 supraespinal multisensorial (y la coordinación muscular 7), además de la fuerza muscular es fundamental para la recuperación de equilibrio que no existe en los protocolos actuales. Hacia la integración multisensorial, nuestra hipótesis 8 en electroterapia no invasiva volitivamente accionado (NMES / SES) es que este comportamiento de adaptación puede ser en forma y facilitado por la modulación de la percepción activa de entradas sensoriales durante el movimiento con ayuda de SES NMES / de la extremidad afectada de tal manera que la cerebro puede incorporar esta información en la posterior salida de movimiento mediante la contratación de las vías motoras alternos 9, si es necesario. Para lograr volitivamente impulsado el entrenamiento del equilibrio con ayuda de SES SNEM / en un recurso-poor ajuste, un ser humano-máquina de bajo costo (HMI) fue desarrollado mediante el aprovechamiento de software de código abierto disponible y los últimos avances en tecnología de sensores de videojuegos off-the-shelf de retro-alimentación visual-auditivo. EENM consiste en la estimulación eléctrica coordinada de los nervios y músculos que se ha demostrado para mejorar la fuerza muscular y reducir la espasticidad 10. Además, SES consiste en la estimulación de los nervios sensoriales con corriente eléctrica para evocar sensaciones donde el trabajo preliminar publicada el 11 demostraron que la estimulación subsensorial aplica sobre los músculos tibial anterior solo es eficaz en la atenuación de la oscilación postural. En este caso, el operador hará posible la integración sensorial-motriz durante la terapia de equilibrio posterior al accidente cerebrovascular interactivo donde volitivamente-driven SNEM / SES para los músculos del tobillo actuarán como un amplificador muscular (con EENM), así como mejorar la retroalimentación aferente (con SES) a asistir a las estrategias de los tobillos sanos 12,13,14 para mantener la posición vertical durante balancea posturales. Esto esbasado en la hipótesis presentada en Dutta et al. 8 que un aumento de la excitabilidad corticoespinal de los músculos del tobillo que se han efectuado a través de electroterapia no invasiva puede prestar a una mejora de la modulación supraespinal de rigidez del tobillo. De hecho, el trabajo previo ha demostrado que NMES / SES provoca cambios duraderos en la excitabilidad corticoespinal, posiblemente como resultado de la co-activación de motor y fibras sensoriales 15,16. Por otra parte, Khaslavskaia y Sinkjaer 17 mostraron en los seres humanos que el motor de accionamiento simultáneo cortical presente en el momento de la EENM / SES realzado la excitabilidad cortical motora. Por lo tanto, impulsada volitivamente-SNEM / SES puede inducir la neuroplasticidad a corto plazo en los reflejos espinales (por ejemplo, Ia inhibición recíproca 17) donde las neuronas corticoespinal que se proyectan a través de las vías descendentes a un grupo de neuronas motoras dado pueden inhibir la piscina motoneuronas antagónica a través de interneuronas Ia-inhibitorios en los seres humanos 18, como se muestra en la Figura 1, hacia una oparadigma de condicionamiento perant (véase Dutta et al. 8). <img alt="Figura 1" src="/files/ftp_upload/52394/52394fig1.jpg" /> Figura 1: El concepto (. Detalles en Dutta et al 21) subyacente interfaz hombre-máquina interactiva (HMI) para conducir el centro de presión (CoP) del cursor a la meta con claves para mejorar la coordinación de los músculos del tobillo bajo la estimulación eléctrica neuromuscular volitivamente conducido (SNEM) -assisted terapia de equilibrio visuomotor EEG:. electroencefalografía, MN: α-motoneurona, IN: interneuronas inhibidoras de Ia, EMG: electromiograma, GRD: ganglio de la raíz dorsal. Reproducido de 8 y 37. <a href="https://www.jove.com/files/ftp_upload/52394/52394fig1large.jpg" target="_blank">Haga clic aquí para ver una versión más grande de esta figura.</a> El antero-posterior (AP) desplazamientos en el centro de masa (COM) se llevan a cabopor flexores plantares del tobillo (tales como los músculos gastrocnemio medial y sóleo) y flexores dorsales (tales como el músculo tibial anterior), mientras que medio-lateral (ML) desplazamientos se llevan a cabo por inversores de tobillo (tales como el músculo tibial anterior) y eversores (como peroneo largo y corto músculos). En consecuencia, relacionadas con la apoplejía impedimentos tobillo incluyendo debilidad del tobillo dorsiflexor músculos y aumento de la espasticidad de los músculos flexor plantar del tobillo conducen a un deterioro del control postural. Aquí, los programas de entrenamiento de la agilidad 6 se puede aprovechar en una realidad virtual (VR) plataforma de juegos basada en que desafían el equilibrio dinámico donde las tareas se incrementan progresivamente en dificultad que puede ser más eficaz que el programa de ejercicios de estiramiento estático / de desplazamiento de peso en la prevención de caídas 6. Por ejemplo, los sujetos pueden realizar volitivamente impulsado AP asistida SNEM / SES y los desplazamientos ML durante una dinámica de equilibrio tarea visomotora, donde la dificultad se puede aumentar progresivamente a ameliorate problemas tras un ictus tobillo específica de control en el cambio de peso durante la bipedestación. Hacia volitivamente impulsado la terapia asistida equilibrio SNEM / SES en un entorno pobre en recursos, presentamos un operador de bajo costo para Mobile Brain / Imagen de Cuerpo (mobi) 19, hacia la retro-alimentación visual-auditiva que también puede ser utilizado para la recolección de datos de baja sensores de costes para la exploración de datos fuera de línea en MobiLab (véase Ojeda et al. 20).

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			<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

Un accidente cerebrovascular se produce cuando una arteria que lleva sangre desde el corazón a un área en el cerebro estalla o un coágulo obstruye el flujo de sangre al cerebro impidiendo de este modo la entrega de oxígeno y nutrientes. Aproximadamente la mitad de los supervivientes del accidente cerebrovascular se quedan con algún grado de discapacidad. Se necesitan con urgencia metodologías innovadoras para la neurorrehabilitación reparadora para reducir la discapacidad a largo plazo. La capacidad del sistema nervioso para reorganizar su estructura, función y conexiones como respuesta a los estímulos intrínsecos o extrínsecos se llama neuroplasticidad. La neuroplasticidad está implicado en los trastornos funcionales tras un ictus, sino también en la rehabilitación. neuroplastic cambios beneficiosos pueden ser facilitadas con electroterapia no invasivos, tales como la estimulación eléctrica neuromuscular (EENM) y la estimulación eléctrica sensorial (SES). EENM consiste en la estimulación eléctrica coordinada de los nervios motores y los músculos para activarlos con pulsos cortos de corriente eléctrica continua mientras SES invoIves estimulación de los nervios sensoriales con corriente eléctrica resultante en las sensaciones que varían desde apenas perceptible a muy desagradable. En este caso, la participación cortical activo en los procedimientos de rehabilitación puede ser facilitada por la conducción de la electroterapia no invasiva con bioseñales (electromiografía (EMG), electroencefalograma (EEG), electrooculogram (EOG)) que representan la percepción simultánea activa y el esfuerzo volitivo. Para lograr esto en un entorno pobre en recursos, por ejemplo, en los países de ingresos bajos y medianos, se presenta un bajo costo humano-máquina (HMI) mediante el aprovechamiento de los avances recientes en la tecnología de sensores de videojuegos off-the-shelf. En este trabajo, se discute la interfaz de software de código abierto que integra sensores de bajo coste off-the-shelf de retro-alimentación visual-auditivo con electroterapia no invasivo para ayudar al control postural durante la rehabilitación equilibrio. Se demuestra la prueba de concepto en voluntarios sanos.

La Figura 4 muestra las características de la mirada del ojo que fueron extraídos fuera de línea para la cuantificación de un rendimiento sano durante una tarea de búsqueda suave. Las siguientes características se extrajeron como se muestra en la Tabla 1: Característica 1 = porcentaje de desviación entre la posición estímulo objetivo y el centroide de los puntos de fijación de los p...

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-máquina humana integración de sensores de bajo coste con un sistema de estimulación eléctrica neuromuscular para la Rehabilitación de Balance post-accidente cerebrovascular

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 ...

The overall goal of this procedure is to apply video game sensor technology towards a low cost human machine interface for balance rehabilitation. This is accomplished by first setting up mobile brain body imaging, or MoBI equipment, and software. The second step is to place MoBI sensors on the body to capture physiological data.Next, an eye tracker is used to evaluate post stroke visual pursuit eye movements. Eye tracking will show that gaze related indices can help in delineating post-stroke oculomotor deficits, which may be relevant for planning visuomotor balance therapy. Then, sensors for neuromuscular electrical stimulation, or NMES, assisted in visuomotor balance therapy, under MoBI, are calibrated.The final step is to collect multi-sensor data from low cost sensors during visuomotor balance therapy. We are extending this technology for our home base rehabilitation for stroke patients who suffer from balance loss. Our system includes gaze based, prognostic dual, and one gaze spectrum as an important ingredient in visuomotor balance therapy.So this paradigm shifting technology captures how the visual system, the motor system, and the balance systems walks together after stroke and tries to rehabilitate them through training. So in principle, this technic can be used in other conditions, like Autism Spectrum Disorder, Parkinsonism, Traumatic Brain Injury, and also psychomotor disturbance due to depression. All can be rehabilitated in this training system.Begin by obtaining a projection screen to display the visual bio feedback. Adjust the height so that the center of the screen will be at the subject's eye level. Then place the motion caption sensor in front of the projection screen and aim it at the volume of motion capture.Confirm that the volume of motion capture is 1.5 meters to 2.5 meters in front of the motion capture sensor. Next, place the balance board on the floor, about 2.0 meters away from the motion capture sensor. Leave enough room around the balance board to ensure full body movement.To begin sensor placement for electromyography, or EMG, in the NMES system, ask the subject to sit on a chair. Place the EMG and NMES electrodes bilaterally on the Medial Gastrocnemius and Tibialis Anterior muscles of the subject. Then, connect the electrodes to the wireless NMES simulator system.Next, place the electroencephalogram, or EEG cap, on the subject's head by following the international 10-20 system. Use conductive paste to adhere the electrodes, seen here to the scalp, before connecting them to the wireless EEG headset. Place two passive EEG electrodes above and below one eye to capture the vertical electrooculogram, or EOG.Add another two to the outer campus of each eye to capture the horizontal EOG. Finally, place two passive EEG electrodes on the subject's earlobes to serve as EEG reference electrodes. Begin by placing the eye tracker just below the visual feedback computer monitor and connect it to the visual feedback computer using a USB 3 port.Then, ask the subject to sit at the desk at a distance of 50 centimeters from the eye tracker, adjust the visual feedback computer monitor so that the subject's eyes are at the center of the monitor. In the visual feedback computer, open the eye tribe server and eye tribe when-you-eye to ensure whether the subject's eyes are detected by the Gooey and to perform the eye tracker calibration routine subsequently. Next, ask the subject to look straight at the visual feedback computer monitor for visual cues.Run the eye tracker calibration routine by clicking on the calibrate tab in the Gooey. Run the visual underscore stimulus dot exc in the smart eye folder to execute the virtual reality based interface. Subsequently, run the smart eye dot exc program present in the smart eye folder to acquire the subject's eye gaze data that is synchronized with the virtual reality based task.Ask the subject to follow the fixed and moving visual stimuli at various positions on the visual feedback computer screen in order to evaluate post stroke pursuit eye movements. First, connect the eye tracker and balance board sensors to the visual feedback computer. Turn on the balance board, or BB sensor.Press the button on the BB sensor to make the remote discoverable in the menu. Click on the show or hide icon in the system's task bar, and click bluetooth device icon. Then, click on the added device option and pair the BB as a bluetooth device without using the code to the visual feedback computer.Once the balance board is connected to the visual feedback computer, open the VBT folder, and run the We BB interface dot m file to establish Matt lab BB interface. Have the subject stand on the balance board. Click OK to begin the calibration, then enter the subject's weight and click OK again.Next, connect and turn on the motion capture sensor to the data acquisition computer and ensure that it has fully booted, which is indicated by the green light. Open the LSL folder and start Mocap software to begin streaming of the motion capture sensor data. Turn on the EEG and EOG data acquisition systems connected to the data acquisition computer.To do this, first open the LSL folder and open open vibe acquisition server with LSL dot cmd. Finally, select emotive EPOC from the menu for EEG and EOG and configure the module by clicking on driver properties. Then, click on connect and click on play to start the acquisition server.Begin by asking the subject to stand on the balance board and attach a safety harness. Set a minimum baseline NMES level for upright standing by setting the stimulation frequency at 20 hurtz. Then, increase the pulse width and current level in the NMES software installed in the data acquisition computer until upright standing has been achieved.For NMES assisted VBT, ask the subject to sit on a chair, facing the motion capture sensor with their feet on the balance board. Run the calib sensors program in the data collect folder in order to collect multi sensor calibration data. Finally, ask the subject to perform self initiated maximal reach movements in different directions that affect center of mass location on the visual feedback.Begin by running the collect baseline program in the data collect folder to collect baseline resting state, eyes open, multi sensor data. To do this, ask the subject to stand still for two minutes and look straight at the center of mass location on the visual feedback. Then, run the collected VBT program in the data collect folder to collect sensor data during VBT.Connect the visual feedback computers video output to the projection screen and run the smart IVRT tasks dot exe file in the VBT folder in the visual feedback computer to launch the smart IVRT tasks Gooey. Then, ask the subject to pay attention to the audio and visual prompt on the computer screen and steer the cursor as fast as possible towards randomly presented peripheral targets. Following the Move Phase, ask the subject to hold the cursor at the target location for one second.Following the peripheral hold phase, ask the subject to return back to the central hold position while the system acquires the subject's two d coordinates of center of pressure and the two d coordinates of the gaze data. The eye gaze features were collected with the eye tracker to quantify a subjects performance during a smooth pursuit task for later comparison with post stroke VBT data. Then, for VBT, the protocol used to modify functional reach task to quantify the subject's ability to volitionally shift their center of pressure position as quickly as possible without losing balance, while cued with visual feedback.Here, EOG data shows that during VBT, the FD ratio, or ratio of fixation duration on the target, and the fixation duration on the cursor, increased while the normalized mean squared error decreased. While attempting this procedure it is very important to consider the safety and the comfort of the stroke patient. We expect that a virtual reality based balance rehabilitation system will be potent to address balance disorders of stroke patients.So following this procedure, other additional clinical measures, like the clinical measure of balance and mobility can be far from to comprehensively know how quantitive measures compared to other standard clinical parameters so that we can get a comprehensive picture of functional deficit of a stroke patient and we can comprehensively address this issue in the rehabilitation.

Research

JoVE Journal

Neuroscience

Combining Transcranial Magnetic Stimulation and fMRI to Examine the Default Mode Network

La combinación de Estimulación Magnética Transcraneal y fMRI para examinar la red en modo por defecto

The default mode network is a group of brain regions that are active when an individual is not focused on the outside world and the brain is at "wakeful ...

Investigación

Neurociencias

The NeuroStar TMS Device: Conducting the FDA Approved Protocol for Treatment of Depression

El dispositivo de TMS NeuroStar: Realización de la FDA aprobó el Protocolo para el tratamiento de la depresión

The Neuronetics NeuroStar Transcranial Magnetic Stimulation (TMS) System is a class II medical device that produces brief duration, pulsed magnetic ...

Investigating Outer Hair Cell Motility with a Combination of External Alternating Electrical Field Stimulation and High-speed Image Analysis

La investigación de la motilidad células ciliadas externas, con una combinación de la estimulación externa alterna de campo eléctrico de alta velocidad y Análisis de Imágenes

OHCs are cylindrical sensorimotor cells located in the Organ of Corti, the auditory organ inside the mammalian inner ear. The name "hair cells" derives ...

Reproducible Mouse Sciatic Nerve Crush and Subsequent Assessment of Regeneration by Whole Mount Muscle Analysis

Ratón reproducible aplastamiento del nervio ciático y posterior evaluación de la regeneración mediante el análisis de músculo entero Monte

Regeneration in the peripheral nervous system (PNS) is widely studied both for its relevance to human disease and to understand the robust regenerative ...

A Low Cost Setup for Behavioral Audiometry in Rodents

Una instalación de Bajo Costo para audiometría conductual en roedores

In auditory animal research it is crucial to have precise information about basic hearing parameters of the animal subjects that are involved in the ...

Isolation of Cerebrospinal Fluid from Rodent Embryos for use with Dissected Cerebral Cortical Explants

Aislamiento de líquido cefalorraquídeo de embriones de roedores para su uso con disecados explantes cortical cerebral

The CSF is a complex fluid with a dynamically varying proteome throughout development and in adulthood. During embryonic development, the nascent CSF ...

A Low-cost Method for Analyzing Seizure-like Activity and Movement in Drosophila

A Low-cost Method for Analyzing Seizure-like Activity and Movement in Drosophila

Un método de bajo costo para el Análisis convulsiva actividad y movimiento en<em&gt; Drosophila</em

Video tracking systems have been used widely to analyze Drosophila melanogaster movement and detect various abnormalities in locomotive behavior. While ...

Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation

Evaluación de la función neuromuscular Usando percutánea estimulación nerviosa eléctrica

Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, ...

High-density Electroencephalographic Acquisition in a Rodent Model Using Low-cost and Open-source Resources

De alta densidad Electroencefalográfica Adquisición en un modelo de roedor Uso de recursos de bajo costo y de código abierto

Advanced electroencephalographic analysis techniques requiring high spatial resolution, including electrical source imaging and measures of network ...

Neurobehavioral Assessments in a Mouse Model of Neonatal Hypoxic-ischemic Brain Injury

Evaluación neuroconductual en un modelo murino de lesión de cerebro hipóxico-isquémica Neonatal

We performed unilateral carotid artery occlusion on CD-1 mice to create a neonatal hypoxic-ischemic (HI) model and investigated the effects of neonatal HI ...