Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist).

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

A simulation-based approach to improve decoded neurofeedback performance.

The neural correlates of specific brain functions such as visual orientation tuning and individual finger movements can be revealed using multivoxel pattern analysis (MVPA) of fMRI data. Neurofeedback based on these distributed patterns of brain activity presents a unique ability for precise neuromodulation. Recent applications of this technique, known as decoded neurofeedback, have manipulated fear conditioning, visual perception, confidence judgements and facial preference. However, there has yet to be an empirical justification of the timing and data processing parameters of these experiments. Suboptimal parameter settings could impact the efficacy of neurofeedback learning and contribute to the 'non-responder' effect. The goal of this study was to investigate how design parameters of decoded neurofeedback experiments affect decoding accuracy and neurofeedback performance. Subjects participated in three fMRI sessions: two 'finger localizer' sessions to identify the fMRI patterns associated with each of the four fingers of the right hand, and one 'finger finding' neurofeedback session to assess neurofeedback performance. Using only the localizer data, we show that real-time decoding can be degraded by poor experiment timing or ROI selection. To set key parameters for the neurofeedback session, we used offline simulations of decoded neurofeedback using data from the localizer sessions to predict neurofeedback performance. We show that these predictions align with real neurofeedback performance at the group level and can also explain individual differences in neurofeedback success. Overall, this work demonstrates the usefulness of offline simulation to improve the success of real-time decoded neurofeedback experiments.

Self-regulation strategy, feedback timing and hemodynamic properties modulate learning in a simulated fMRI neurofeedback environment.

Direct manipulation of brain activity can be used to investigate causal brain-behavior relationships. Current noninvasive neural stimulation techniques are too coarse to manipulate behaviors that correlate with fine-grained spatial patterns recorded by fMRI. However, these activity patterns can be manipulated by having people learn to self-regulate their own recorded neural activity. This technique, known as fMRI neurofeedback, faces challenges as many participants are unable to self-regulate. The causes of this non-responder effect are not well understood due to the cost and complexity of such investigation in the MRI scanner. Here, we investigated the temporal dynamics of the hemodynamic response measured by fMRI as a potential cause of the non-responder effect. Learning to self-regulate the hemodynamic response involves a difficult temporal credit-assignment problem because this signal is both delayed and blurred over time. Two factors critical to this problem are the prescribed self-regulation strategy (cognitive or automatic) and feedback timing (continuous or intermittent). Here, we sought to evaluate how these factors interact with the temporal dynamics of fMRI without using the MRI scanner. We first examined the role of cognitive strategies by having participants learn to regulate a simulated neurofeedback signal using a unidimensional strategy: pressing one of two buttons to rotate a visual grating that stimulates a model of visual cortex. Under these conditions, continuous feedback led to faster regulation compared to intermittent feedback. Yet, since many neurofeedback studies prescribe implicit self-regulation strategies, we created a computational model of automatic reward-based learning to examine whether this result held true for automatic processing. When feedback was delayed and blurred based on the hemodynamics of fMRI, this model learned more reliably from intermittent feedback compared to continuous feedback. These results suggest that different self-regulation mechanisms prefer different feedback timings, and that these factors can be effectively explored and optimized via simulation prior to deployment in the MRI scanner.

The effect of hip exoskeleton weight on kinematics, kinetics, and electromyography during human walking.

In exoskeleton research, transparency is the degree to which a device hinders the movement of the user, a critical component of performance and usability. Transparency is most often evaluated individually, thus lacking generalization. Our goal was to systematically evaluate transparency due to inertial effects on gait of a hypothetical hip exoskeleton. We predicted that the weight distribution around the pelvis and the amount of weight applied would change gait characteristics. We instructed 21 healthy individuals to walk on a treadmill while bearing weights on the pelvis between 4 and 8 kg in three different configurations, bilaterally, unilaterally (left side) and on the lumbar portion of the back (L4). We measured kinematics, kinetics, and muscle activity during randomly ordered trials of 1.5 min at typical walking speed. We also calculated the margin of stability to measure medial-lateral stability. We observed that loading the hips bilaterally with 4 kg had no changes in kinematics, kinetics, dynamic stability, or muscle activity, but above 6 kg, sagittal joint power was increased. Loading the lumbar area increased posterior pelvic tilt at 6 kg and decreased dynamic stability at 4 kg, with many individuals reporting some discomfort. For the unilateral placement, above 4 kg dynamic stability was decreased and hip joint power was increased, and above 6 kg the pelvis begins to dip towards the loaded side. These results show the different effects of weight distribution around the pelvis. This study represents a novel, systematic approach to characterizing transparency in exoskeleton design (clinicaltrials.gov: NCT05120115).

Assessment of Upper-Extremity Joint Angles Using Harmony Exoskeleton.

The biomechanical complexity of the human shoulder, while critical for functionality, poses a challenge for objective assessment during sensorimotor rehabilitation. With built-in sensing capabilities, robotic exoskeletons have the potential to serve as tools for both intervention and assessment. The bilateral upper-extremity Harmony exoskeleton is capable of full shoulder articulation, forearm flexion-extension, and wrist pronation-supination motions. The goal of this paper is to characterize Harmony's anatomical joint angle tracking accuracy towards its use as an assessment tool. We evaluated the agreement between anatomical joint angles estimated from the robot's sensor data and optical motion capture markers attached to the human user. In 9 healthy participants we examined 6 upper-extremity joint angles, including shoulder girdle angles, across 4 different motions, varying active/passive motion of the user and physical constraint of the trunk. We observed mostly good to excellent levels of agreement between measurement systems with for shoulder and distal joints, magnitudes of average discrepancies varying from 0.43° to 16.03° and width of LoAs ranging between 9.44° and 41.91°. Slopes were between 1.03 and 1.43 with r > 0.9 for shoulder and distal joints. Regression analysis suggested that discrepancies observed between measured robot and human motions were primarily due to relative motion associated with soft tissue deformation. The results suggest that the Harmony exoskeleton is capable of providing accurate measurements of arm and shoulder joint kinematics. These findings may lead to robot-assisted assessment and intervention of one of the most complex joint structures in the human body.

Preswing knee flexion assistance is coupled with hip abduction in people with stiff-knee gait after stroke.

BACKGROUND AND PURPOSE: Stiff-knee gait is defined as reduced knee flexion during the swing phase. It is accompanied by frontal plane compensatory movements (eg, circumduction and hip hiking) typically thought to result from reduced toe clearance. As such, we examined if knee flexion assistance before foot-off would reduce exaggerated frontal plane movements in people with stiff-knee gait after stroke. METHODS: We used a robotic knee orthosis to assist knee flexion torque during the preswing phase in 9 chronic stroke subjects with stiff-knee gait on a treadmill and compared peak knee flexion, hip abduction, and pelvic obliquity angles with 5 nondisabled control subjects. RESULTS: Maximum knee flexion angle significantly increased in both groups, but instead of reducing gait compensations, hip abduction significantly increased during assistance in stroke subjects by 2.5 degrees , whereas no change was observed in nondisabled control subjects. No change in pelvic obliquity was observed in either group. CONCLUSIONS: Hip abduction increased when stroke subjects received assistive knee flexion torque at foot-off. These findings are in direct contrast to the traditional belief that pelvic obliquity combined with hip abduction is a compensatory mechanism to facilitate foot clearance during swing. Because no evidence suggested a voluntary mechanism for this behavior, we argue that these results were most likely a reflection of an altered motor template occurring after stroke.

Brainstem BOLD response to visual and acoustic stimuli.

Understanding the fundamental roles of brainstem function resulting in proper motor control is critical to motor-rehabilitation after brain injuries. In particular, vestibular and reticular formation nuclei are thought to be associated with spasticity in chronic stroke patients. We used two kinds of stimuli in 10 healthy subjects to activate these nuclei while collecting high-resolution (1.5-mm) fMRI across the majority of brainstem. Optokinetic stimuli evoked illusory self-motion to activate the vestibular nuclei. Acoustic-startle stimuli were sets of loud tones designed to activate of the reticular formation. We summarized the response represented in a form of activation volume, mean percent signal change, and the phase delay (time lag) following the stimulus. We observed patterns of significant activations in the brainstem but did not find significant differences between the stimulus. We conclude that more sensitive measurement techniques are needed to reliably detect vestibular and reticular formation nuclei responses.

A Highly Backdrivable, Lightweight Knee Actuator for Investigating Gait in Stroke.

Many of those who survive a stroke develop a gait disability known as stiff-knee gait (SKG). Characterized by reduced knee flexion angle during swing, people with SKG walk with poor energy efficiency and asymmetry due to the compensatory mechanisms required to clear the foot. Previous modeling studies have shown that knee flexion activity directly before the foot leaves the ground, and this should result in improved knee flexion angle during swing. The goal of this research is to physically test this hypothesis using robotic intervention. We developed a device that is capable of assisting knee flexion torque before swing but feels imperceptible (transparent) for the rest of the gait cycle. This device uses sheathed Bowden cable to control the deflection of a compliant torsional spring in a configuration known as a Series Elastic Remote Knee Actuator (SERKA). In this investigation, we describe the design and evaluation of SERKA, which includes a pilot experiment on stroke subjects. SERKA could supply a substantial torque (12 N· m) in less than 20 ms, with a maximum torque of 41 N·m. The device resisted knee flexion imperceptibly when desired, at less than 1 N·m rms torque during normal gait. With the remote location of the actuator, the user experiences a mass of only 1.2 kg on the knee. We found that the device was capable of increasing both peak knee flexion angle and velocity during gait in stroke subjects. Thus, the SERKA is a valid experimental device that selectively alters knee kinetics and kinematics in gait after stroke.

Design and Characterization of an Exoskeleton for Perturbing the Knee During Gait.

OBJECTIVE: An improved understanding of mechanical impedance modulation in human joints would provide insights about the neuromechanics underlying functional movements. Experimental estimation of impedance requires specialized tools with highly reproducible perturbation dynamics and reliable measurement capabilities. This paper presents the design and mechanical characterization of the ETH Knee Perturbator: an actuated exoskeleton for perturbing the knee during gait. METHODS: A novel wearable perturbation device was developed based on specific experimental objectives. Bench-top tests validated the device's torque limiting capability and characterized the time delays of the on-board clutch. Further tests demonstrated the device's ability to perform system identification on passive loads with static initial conditions. Finally, the ability of the device to consistently perturb human gait was evaluated through a pilot study on three unimpaired subjects. RESULTS: The ETH Knee Perturbator is capable of identifying mass-spring systems within 15% accuracy, accounting for over 95% of the variance in the observed torque in 10 out of 16 cases. Five-degree extension and flexion perturbations were executed on human subjects with an onset timing precision of 2.52% of swing phase duration and a rise time of 36.5 ms. CONCLUSION: The ETH Knee Perturbator can deliver safe, precisely timed, and controlled perturbations, which is a prerequisite for the estimation of knee joint impedance during gait. SIGNIFICANCE: Tools such as this can enhance models of neuromuscular control, which may improve rehabilitative outcomes following impairments affecting gait and advance the design and control of assistive devices.

BOLD correlations to force in precision grip: an event-related study.

The introduction of functional neuroimaging has resulted in a profusion of knowledge on various topics, including how blood oxygenation level dependent (BOLD) signal in the brain is related to force. To date, studies that have explicitly examined this relationship have used block designs. To gain a better understanding of the networks involved in human motor control, analyses sensitive to temporal relationships, such as Granger Causality or Dynamic Causal Modeling, require event-related designs. Therefore the goal of this experiment was to examine whether similar or even better relationships between BOLD and force during precision grip could be determined with an event-related design. Five healthy subjects exerted forces at 10%, 20% and 30% of maximum voluntary force, along with an observation condition. We report that the BOLD signal was linearly correlated with precision grip force in primary sensorimotor cortex and cerebellum, showing slightly better correlations than previous work. The results provide a clearer picture regarding the sensitivity of BOLD signal to force and show that event-related designs can be more appropriate than block designs in motor tasks.

Catastrophe and stability analysis of a cable-driven actuator.

Recent work in human-robot interaction has revealed the need for compliant, human-friendly devices. One such device, known as the MARIONET, is a cable-driven single joint actuator with the intended applications of physical rehabilitation and assistive devices. In this work, the stability of the nonlinear system is determined in regards to its equilibria in a wide variety of configurations. In certain configurations, the canonical version of this mechanism experiences an interesting mathematical behavior known as "catastrophes". This behavior may be disadvantageous toward control or even safety. Several cases are thoroughly investigated, two cases where each of two degrees of freedom loses control, and the final case explores the use of a mechanical advantage such as a block and tackle. The study concludes that for a range of design options, the MARIONET does not suffer from any catastrophes. However, the unique behaviors such as a unidirectional bifurcation produced by certain configurations may have use outside of our objectives, perhaps as a type of switch or valve.