Decoding of Ankle Joint Movements in Stroke Patients Using Surface Electromyography.

Stroke is a cerebrovascular disease (CVD), which results in hemiplegia, paralysis, or death. Conventionally, a stroke patient requires prolonged sessions with physical therapists for the recovery of motor function. Various home-based rehabilitative devices are also available for upper limbs and require minimal or no assistance from a physiotherapist. However, there is no clinically proven device available for functional recovery of a lower limb. In this study, we explored the potential use of surface electromyography (sEMG) as a controlling mechanism for the development of a home-based lower limb rehabilitative device for stroke patients. In this experiment, three channels of sEMG were used to record data from 11 stroke patients while performing ankle joint movements. The movements were then decoded from the sEMG data and their correlation with the level of motor impairment was investigated. The impairment level was quantified using the Fugl-Meyer Assessment (FMA) scale. During the analysis, Hudgins time-domain features were extracted and classified using linear discriminant analysis (LDA) and artificial neural network (ANN). On average, 63.86% ± 4.3% and 67.1% ± 7.9% of the movements were accurately classified in an offline analysis by LDA and ANN, respectively. We found that in both classifiers, some motions outperformed others (p < 0.001 for LDA and p = 0.014 for ANN). The Spearman correlation (ρ) was calculated between the FMA scores and classification accuracies. The results indicate that there is a moderately positive correlation (ρ = 0.75 for LDA and ρ = 0.55 for ANN) between the two of them. The findings of this study suggest that a home-based EMG system can be developed to provide customized therapy for the improvement of functional lower limb motion in stroke patients.

Decoding Attempted Hand Movements in Stroke Patients Using Surface Electromyography.

Brain- and muscle-triggered exoskeletons have been proposed as a means for motor training after a stroke. With the possibility of performing different movement types with an exoskeleton, it is possible to introduce task variability in training. It is difficult to decode different movement types simultaneously from brain activity, but it may be possible from residual muscle activity that many patients have or quickly regain. This study investigates whether nine different motion classes of the hand and forearm could be decoded from forearm EMG in 15 stroke patients. This study also evaluates the test-retest reliability of a classical, but simple, classifier (linear discriminant analysis) and advanced, but more computationally intensive, classifiers (autoencoders and convolutional neural networks). Moreover, the association between the level of motor impairment and classification accuracy was tested. Three channels of surface EMG were recorded during the following motion classes: Hand Close, Hand Open, Wrist Extension, Wrist Flexion, Supination, Pronation, Lateral Grasp, Pinch Grasp, and Rest. Six repetitions of each motion class were performed on two different days. Hudgins time-domain features were extracted and classified using linear discriminant analysis and autoencoders, and raw EMG was classified with convolutional neural networks. On average, 79 ± 12% and 80 ± 12% (autoencoders) of the movements were correctly classified for days 1 and 2, respectively, with an intraclass correlation coefficient of 0.88. No association was found between the level of motor impairment and classification accuracy (Spearman correlation: 0.24). It was shown that nine motion classes could be decoded from residual EMG, with autoencoders being the best classification approach, and that the results were reliable across days; this may have implications for the development of EMG-controlled exoskeletons for training in the patient's home.

Skin Lesion Segmentation from Dermoscopic Images Using Convolutional Neural Network.

Clinical treatment of skin lesion is primarily dependent on timely detection and delimitation of lesion boundaries for accurate cancerous region localization. Prevalence of skin cancer is on the higher side, especially that of melanoma, which is aggressive in nature due to its high metastasis rate. Therefore, timely diagnosis is critical for its treatment before the onset of malignancy. To address this problem, medical imaging is used for the analysis and segmentation of lesion boundaries from dermoscopic images. Various methods have been used, ranging from visual inspection to the textural analysis of the images. However, accuracy of these methods is low for proper clinical treatment because of the sensitivity involved in surgical procedures or drug application. This presents an opportunity to develop an automated model with good accuracy so that it may be used in a clinical setting. This paper proposes an automated method for segmenting lesion boundaries that combines two architectures, the U-Net and the ResNet, collectively called Res-Unet. Moreover, we also used image inpainting for hair removal, which improved the segmentation results significantly. We trained our model on the ISIC 2017 dataset and validated it on the ISIC 2017 test set as well as the PH2 dataset. Our proposed model attained a Jaccard Index of 0.772 on the ISIC 2017 test set and 0.854 on the PH2 dataset, which are comparable results to the current available state-of-the-art techniques.

Performance Evaluation of Convolutional Neural Network for Hand Gesture Recognition Using EMG.

Electromyography (EMG) is a measure of electrical activity generated by the contraction of muscles. Non-invasive surface EMG (sEMG)-based pattern recognition methods have shown the potential for upper limb prosthesis control. However, it is still insufficient for natural control. Recent advancements in deep learning have shown tremendous progress in biosignal processing. Multiple architectures have been proposed yielding high accuracies (>95%) for offline analysis, yet the delay caused due to optimization of the system remains a challenge for its real-time application. From this arises a need for optimized deep learning architecture based on fine-tuned hyper-parameters. Although the chance of achieving convergence is random, however, it is important to observe that the performance gain made is significant enough to justify extra computation. In this study, the convolutional neural network (CNN) was implemented to decode hand gestures from the sEMG data recorded from 18 subjects to investigate the effect of hyper-parameters on each hand gesture. Results showed that the learning rate set to either 0.0001 or 0.001 with 80-100 epochs significantly outperformed (p < 0.05) other considerations. In addition, it was observed that regardless of network configuration some motions (close hand, flex hand, extend the hand and fine grip) performed better (83.7% ± 13.5%, 71.2% ± 20.2%, 82.6% ± 13.9% and 74.6% ± 15%, respectively) throughout the course of study. So, a robust and stable myoelectric control can be designed on the basis of the best performing hand motions. With improved recognition and uniform gain in performance, the deep learning-based approach has the potential to be a more robust alternative to traditional machine learning algorithms.

A Multiday Evaluation of Real-Time Intramuscular EMG Usability with ANN.

Recent developments in implantable technology, such as high-density recordings, wireless transmission of signals to a prosthetic hand, may pave the way for intramuscular electromyography (iEMG)-based myoelectric control in the future. This study aimed to investigate the real-time control performance of iEMG over time. A novel protocol was developed to quantify the robustness of the real-time performance parameters. Intramuscular wires were used to record EMG signals, which were kept inside the muscles for five consecutive days. Tests were performed on multiple days using Fitts' law. Throughput, completion rate, path efficiency and overshoot were evaluated as performance metrics using three train/test strategies. Each train/test scheme was categorized on the basis of data quantity and the time difference between training and testing data. An artificial neural network (ANN) classifier was trained and tested on (i) data from the same day (WDT), (ii) data collected from the previous day and tested on present-day (BDT) and (iii) trained on all previous days including the present day and tested on present-day (CDT). It was found that the completion rate (91.6 ± 3.6%) of CDT was significantly better (p < 0.01) than BDT (74.02 ± 5.8%) and WDT (88.16 ± 3.6%). For BDT, on average, the first session of each day was significantly better (p < 0.01) than the second and third sessions for completion rate (77.9 ± 14.0%) and path efficiency (88.9 ± 16.9%). Subjects demonstrated the ability to achieve targets successfully with wire electrodes. Results also suggest that time variations in the iEMG signal can be catered by concatenating the data over several days. This scheme can be helpful in attaining stable and robust performance.

Eye and Voice-Controlled Human Machine Interface System for Wheelchairs Using Image Gradient Approach.

Rehabilitative mobility aids are being used extensively for physically impaired people. Efforts are being made to develop human machine interfaces (HMIs), manipulating the biosignals to better control the electromechanical mobility aids, especially the wheelchairs. Creating precise control commands such as move forward, left, right, backward and stop, via biosignals, in an appropriate HMI is the actual challenge, as the people with a high level of disability (quadriplegia and paralysis, etc.) are unable to drive conventional wheelchairs. Therefore, a novel system driven by optical signals addressing the needs of such a physically impaired population is introduced in this paper. The present system is divided into two parts: the first part comprises of detection of eyeball movements together with the processing of the optical signal, and the second part encompasses the mechanical assembly module, i.e., control of the wheelchair through motor driving circuitry. A web camera is used to capture real-time images. The processor used is Raspberry-Pi with Linux operating system. In order to make the system more congenial and reliable, the voice-controlled mode is incorporated in the wheelchair. To appraise the system's performance, a basic wheelchair skill test (WST) is carried out. Basic skills like movement on plain and rough surfaces in forward, reverse direction and turning capability were analyzed for easier comparison with other existing wheelchair setups on the bases of controlling mechanisms, compatibility, design models, and usability in diverse conditions. System successfully operates with average response time of 3 s for eye and 3.4 s for voice control mode.

Multiday EMG-Based Classification of Hand Motions with Deep Learning Techniques.

Pattern recognition of electromyography (EMG) signals can potentially improve the performance of myoelectric control for upper limb prostheses with respect to current clinical approaches based on direct control. However, the choice of features for classification is challenging and impacts long-term performance. Here, we propose the use of EMG raw signals as direct inputs to deep networks with intrinsic feature extraction capabilities recorded over multiple days. Seven able-bodied subjects performed six active motions (plus rest), and EMG signals were recorded for 15 consecutive days with two sessions per day using the MYO armband (MYB, a wearable EMG sensor). The classification was performed by a convolutional neural network (CNN) with raw bipolar EMG samples as the inputs, and the performance was compared with linear discriminant analysis (LDA) and stacked sparse autoencoders with features (SSAE-f) and raw samples (SSAE-r) as inputs. CNN outperformed (lower classification error) both LDA and SSAE-r in the within-session, between sessions on same day, between the pair of days, and leave-out one-day evaluation (p < 0.001) analyses. However, no significant difference was found between CNN and SSAE-f. These results demonstrated that CNN significantly improved performance and increased robustness over time compared with standard LDA with associated handcrafted features. This data-driven features extraction approach may overcome the problem of the feature calibration and selection in myoelectric control.

Effectiveness of Immersive Virtual Reality-Based Hand Rehabilitation Games for Improving Hand Motor Functions in Subacute Stroke Patients.

Stroke rehabilitation faces challenges in attaining enduring improvements in hand motor function and is frequently constrained by interventional limitations. This research aims to present an innovative approach to the integration of cognitive engagement within visual feedback incorporated into fully immersive virtual reality (VR) based games to achieve enduring improvements. These innovative aspects of interaction provide more functional advantages beyond motivation to efficiently execute repeatedly hand motor tasks. The effectiveness of virtual reality games incorporated with innovative aspects has been investigated for improvements in hand motor functions. A randomized controlled trial was conducted, a total of (n=56) subacute stroke patients were assessed for eligibility and (n=52) patients fulfilled the inclusion criteria. (n=26) patients were assigned to the experimental group and (n=26) patients were assigned to the control group. VR intervention involves four VR based games, developed based on hand movements including flexion/extension, close/open, supination/pronation and pinch. All patients got therapy of 24 sessions, lasting 4 days/week for a total of 6 weeks. Five clinical outcome measures were Fugl- Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index, and Stroke-Specific Quality of Life were assessed to evaluate patients' performance. Results revealed that after therapy there was significant improvement between the groups (p<0.05) and within groups (p<0.05) in all assessment weeks in all clinical outcome measures however, improvement was observed significantly greater in the experimental group due to fully immersive VR-based games. Results indicated that cognitive engagement within visual feedback incorporated in VR-based hand games effectively improved hand motor functions.

ExoMechHand prototype development and testing with EMG signals for hand rehabilitation.

Rehabilitation is a major requirement to improve the quality of life and mobility of patients with disabilities. The use of rehabilitative devices without continuous supervision of medical experts is increasing manifold, mainly due to prolonged therapy costs and advancements in robotics. Due to ExoMechHand's inexpensive cost, high robustness, and efficacy for participants with median and ulnar neuropathies, we have recommended it as a rehabilitation tool in this study. ExoMechHand is coupled with three different resistive plates for hand impairment. For efficacy, ten unhealthy subjects with median or ulnar nerve neuropathies are considered. After twenty days of continuous exercise, three subjects showed improvement in their hand grip, range of motion of the wrist, or range of motion of metacarpophalangeal joints. The condition of the hand is assessed by features of surface-electromyography signals. A Machine-learning model based on these features of fifteen subjects is used for staging the condition of the hand. Machine-learning algorithms are trained to indicate the type of resistive plate to be used by the subject without the need for examination by the therapist. The extra-trees classifier came out to be the most effective algorithm with 98% accuracy on test data for indicating the type of resistive plate, followed by random-forest and gradient-boosting with accuracies of 95% and 93%, respectively. Results showed that the staging of hand condition could be analyzed by sEMG signal obtained from the flexor-carpi-ulnaris and flexor-carpi-radialis muscles in subjects with median and ulnar neuropathies.

Optimizing the performance of convolutional neural network for enhanced gesture recognition using sEMG.

Deep neural networks (DNNs) have demonstrated higher performance results when compared to traditional approaches for implementing robust myoelectric control (MEC) systems. However, the delay induced by optimising a MEC remains a concern for real-time applications. As a result, an optimised DNN architecture based on fine-tuned hyperparameters is required. This study investigates the optimal configuration of convolutional neural network (CNN)-based MEC by proposing an effective data segmentation technique and a generalised set of hyperparameters. Firstly, two segmentation strategies (disjoint and overlap) and various segment and overlap sizes were studied to optimise segmentation parameters. Secondly, to address the challenge of optimising the hyperparameters of a DNN-based MEC system, the problem has been abstracted as an optimisation problem, and Bayesian optimisation has been used to solve it. From 20 healthy people, ten surface electromyography (sEMG) grasping movements abstracted from daily life were chosen as the target gesture set. With an ideal segment size of 200 ms and an overlap size of 80%, the results show that the overlap segmentation technique outperforms the disjoint segmentation technique (p-value < 0.05). In comparison to manual (12.76 ± 4.66), grid (0.10 ± 0.03), and random (0.12 ± 0.05) search hyperparameters optimisation strategies, the proposed optimisation technique resulted in a mean classification error rate (CER) of 0.08 ± 0.03 across all subjects. In addition, a generalised CNN architecture with an optimal set of hyperparameters is proposed. When tested separately on all individuals, the single generalised CNN architecture produced an overall CER of 0.09 ± 0.03. This study's significance lies in its contribution to the field of EMG signal processing by demonstrating the superiority of the overlap segmentation technique, optimizing CNN hyperparameters through Bayesian optimization, and offering practical insights for improving prosthetic control and human-computer interfaces.

Restoration of IL-11 and IL-15 cytokine production post calcium modulators and ROS treatment can assist viral clearance both in vitro and in vivo.

Objectives: Hepatitis B virus (HBV) infection alters the cytokines production to establish persistent infection. A reversion of cytokines back to their normal state can be a promising therapeutic approach to establish an optimal host immune response. Materials and Methods: We investigated the alteration in expression of IL-15 and IL-11 after HBV infection in vitro and in vivo in PBMCs of 63 individuals divided into various HBV-infected patient groups. The mRNA expression was evaluated post-anti-oxidant and calcium modulators treatment by Real-time qPCR. Results: In vitro mRNA expression of both cytokines, post-infection was down-regulated considerably. Interestingly, in line with in vitro results, both cytokines' in vivo expression was intensively down-regulated in chronic HBV-infected individuals rather than healthy controls. Both cytokines' expression was up-regulated in cases of recovery compared with the inactive carriers and chronic HBV-infected individuals. IL-15 mRNA expression was significantly up-regulated in both cell lines post EGTA and Ru360 treatment while a significant increase was observed in the HepAD38 cell line with NAC and BAPTA treatment. IL-11 mRNA expression was significantly up-regulated in the HepG2 cell line after all modulator treatments, whereas in the HepAd38 cell line it was observed after BAPTA treatment. Our results thus indicate that viral infection tends to down-regulate the expression of cytokines and an in vivo up-regulation is an indication of recovery. Conclusion: Treatment of anti-oxidants and calcium modulators has resulted in the successful restoration of these cytokines thus pointing towards the use of calcium modulators to boost natural antiviral cytokine production.

Multivariate wind power curve modeling using multivariate adaptive regression splines and regression trees.

Wind turbine power curve (WTPC) serves as an important tool for wind turbine condition monitoring and wind power forecasting. Due to complex environmental factors and technical issues of the wind turbines, there are many outliers and inconsistencies present in the recorded data, which cannot be removed through any pre-processing technique. However, the current WTPC models have limited ability to understand such complex relation between wind speed and wind power and have limited non-linear fitting ability, which limit their modelling accuracy. In this paper, the accuracy of the WTPC models is improved in two ways: first is by developing multivariate models and second is by proposing MARS as WTPC modeling technique. MARS is a regression-based flexible modeling technique that automatically models complex the nonlinearities in the data using spline functions. Experimental results show that by incorporating additional inputs the accuracy of the power curve estimation is significantly improved. Also by studying the error distribution it is proved that multivariate models successfully mitigate the adverse effect of hidden outliers, as their distribution has higher peaks and lesser standard deviation, which proves that the errors, are more converged to zero compared to the univariate models. Additionally, MARS with its superior non-linear fitting ability outperforms the compared methods in terms of the error metrics and ranks higher than regression trees and several other popular parametric and non-parametric methods. Finally, an outlier detection method is developed to remove the hidden outliers from the data using the error distribution of the modeled power curves.

Deploying efficient net batch normalizations (BNs) for grading diabetic retinopathy severity levels from fundus images.

Diabetic retinopathy (DR) is one of the main causes of blindness in people around the world. Early diagnosis and treatment of DR can be accomplished by organizing large regular screening programs. Still, it is difficult to spot diabetic retinopathy timely because the situation might not indicate signs in the primary stages of the disease. Due to a drastic increase in diabetic patients, there is an urgent need for efficient diabetic retinopathy detecting systems. Auto-encoders, sparse coding, and limited Boltzmann machines were used as a few past deep learning (DL) techniques and features for the classification of DR. Convolutional Neural Networks (CNN) have been identified as a promising solution for detecting and classifying DR. We employ the deep learning capabilities of efficient net batch normalization (BNs) pre-trained models to automatically acquire discriminative features from fundus images. However, we successfully achieved F1 scores above 80% on all efficient net BNs in the EYE-PACS dataset (calculated F1 score for DeepDRiD another dataset) and the results are better than previous studies. In this paper, we improved the accuracy and F1 score of the efficient net BNs pre-trained models on the EYE-PACS dataset by applying a Gaussian Smooth filter and data augmentation transforms. Using our proposed technique, we have achieved F1 scores of 84% and 87% for EYE-PACS and DeepDRiD.

The effects of surface inclination on gastrocnemius, soleus and tibialis anterior muscle activation during gait.

BACKGROUND: Inclined walking is associated with multiple musculoskeletal benefits and is considered a therapeutic exercise. Various patterns of increased and decreased muscle activation with inclined surfaces have been observed in normal muscles, with more focus on the proximal lower limb musculature. OBJECTIVE: The aim of this study was to assess the differences in electromyographic activation of gastrocnemius, soleus, and tibialis anterior at various inclined surfaces during gait. METHODS: Fourteen healthy male participants aged between 17-30 years walked at a self-selected speed at motor driven treadmill on 0, 2 and 4 degrees of inclination. EMG activity of the muscles was recorded using the Delsys Trigno surface EMG system. RESULTS: Results showed that muscular activation of tibialis anterior significantly decreased with increase in the level of inclination (p< 0.05). However, soleus, gastrocnemius medialis and gastrocnemius lateralis showed no significant differences (p> 0.05) in their muscular activation, and no noticeable trends were found. Furthermore, no significant difference was found between all the muscles at ground level and inclined level 2 and 4. CONCLUSION: These differences in activation patterns found in distal extremity can be useful for designing rehabilitation protocols in sports training and for patients with neurological and musculoskeletal pathologies.

Memorability-based multimedia analytics for robotic interestingness prediction system using trimmed Q-learning algorithm.

Mobile robots are increasingly employed in today's environment. Perceiving the environment to perform a task plays a major role in the robots. The service robots are wisely employed in the fully (or) partially known user's environment. The exploration and exploitation of the unknown environment is a tedious task. This paper introduces a novel Trimmed Q-learning algorithm to predict interesting scenes via efficient memorability-oriented robotic behavioral scene activity training. The training process involves three stages: online learning and short-term and long-term learning modules. It is helpful for autonomous exploration and making wiser decisions about the environment. A simplified three-stage learning framework is introduced to train and predict interesting scenes using memorability. A proficient visual memory schema (VMS) is designed to tune the learning parameters. A role-based profile arrangement is made to explore the unknown environment for a long-term learning process. The online and short-term learning frameworks are designed using a novel Trimmed Q-learning algorithm. The underestimated bias in robotic actions must be minimized by introducing a refined set of practical candidate actions. Finally, the recalling ability of each learning module is estimated to predict the interesting scenes. Experiments conducted on public datasets, SubT, and SUN databases demonstrate the proposed technique's efficacy. The proposed framework has yielded better memorability scores in short-term and online learning at 72.84% and in long-term learning at 68.63%.

Melanoma segmentation using deep learning with test-time augmentations and conditional random fields.

In a computer-aided diagnostic (CAD) system for skin lesion segmentation, variations in shape and size of the skin lesion makes the segmentation task more challenging. Lesion segmentation is an initial step in CAD schemes as it leads to low error rates in quantification of the structure, boundary, and scale of the skin lesion. Subjective clinical assessment of the skin lesion segmentation results provided by current state-of-the-art deep learning segmentation techniques does not offer the required results as per the inter-observer agreement of expert dermatologists. This study proposes a novel deep learning-based, fully automated approach to skin lesion segmentation, including sophisticated pre and postprocessing approaches. We use three deep learning models, including UNet, deep residual U-Net (ResUNet), and improved ResUNet (ResUNet++). The preprocessing phase combines morphological filters with an inpainting algorithm to eliminate unnecessary hair structures from the dermoscopic images. Finally, we used test time augmentation (TTA) and conditional random field (CRF) in the postprocessing stage to improve segmentation accuracy. The proposed method was trained and evaluated on ISIC-2016 and ISIC-2017 skin lesion datasets. It achieved an average Jaccard Index of 85.96% and 80.05% for ISIC-2016 and ISIC-2017 datasets, when trained individually. When trained on combined dataset (ISIC-2016 and ISIC-2017), the proposed method achieved an average Jaccard Index of 80.73% and 90.02% on ISIC-2017 and ISIC-2016 testing datasets. The proposed methodological framework can be used to design a fully automated computer-aided skin lesion diagnostic system due to its high scalability and robustness.

Reply to Morone, G.; Giansanti, D. Comment on "Anwer et al. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare 2022, 10, 190".

Thank you so much for your kind remarks [...].

A Low-Cost Device for Measurement of Exhaled Breath for the Detection of Obstructive Lung Disease.

Breath sensor technology can be used in medical diagnostics. This study aimed to build a device to measure the level of hydrogen sulfide, ammonia, acetone and alcohol in exhaled breath of patients as well as healthy individuals. The purpose was to determine the efficacy of these gases for detection of obstructive lung disease. This study was conducted on a total of 105 subjects, where 60 subjects were patients of obstructive lung disease and 45 subjects were healthy individuals. Patients were screened by means of the Pulmonary Function Test (PFT) by a pulmonologist. The gases present in the exhaled breath of all subjects were measured. The level of ammonia (32.29 ± 20.83 ppb), (68.83 ± 35.25 ppb), hydrogen sulfide (0.50 ± 0.26 ppm), (62.71 ± 22.20 ppb), and acetone (103.49 ± 35.01 ppb), (0.66 ± 0.31 ppm) in exhaled breath were significantly different (p < 0.05) between obstructive lung disease patients and healthy individuals, except alcohol, with a p-value greater than 0.05. Positive correlation was found between ammonia w.r.t Forced Expiratory Volume in 1 s (FEV1) (r = 0.74), Forced Vital Capacity (FVC) (r = 0.61) and Forced Expiratory Flow (FEF) (r = 0.63) and hydrogen sulfide w.r.t FEV1 (r = 0.54), FVC (r = 0.41) and FEF (r = 0.37). Whereas, weak correlation was found for acetone and alcohol w.r.t FEV1, FVC and PEF. Therefore, the level of ammonia and hydrogen sulfide are useful breath markers for detection of obstructive lung disease.

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies.

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.

Automatic detection of pathological myopia using machine learning.

Pathological myopia is a severe case of myopia, i.e., nearsightedness. Pathological myopia is also known as degenerative myopia because it ultimately leads to blindness. In pathological myopia, certain myopia-specific pathologies occur at the eye's posterior i.e., Foster-Fuchs's spot, Cystoid degeneration, Liquefaction, Macular degeneration, Vitreous opacities, Weiss's reflex, Posterior staphyloma, etc. This research is aimed at developing a machine learning (ML) approach for the automatic detection of pathological myopia based on fundus images. A deep learning technique of convolutional neural network (CNN) is employed for this purpose. A CNN model is developed in Spyder. The fundus images are first preprocessed. The preprocessed images are then fed to the designed CNN model. The CNN model automatically extracts the features from the input images and classifies the images i.e., normal image or pathological myopia. The best performing CNN model achieved an AUC score of 0.9845. The best validation loss obtained is 0.1457. The results show that the model can be successfully employed to detect pathological myopia from the fundus images.