Machine-learning-based coordination of powered ankle-foot orthosis and functional electrical stimulation for gait control.

This study proposes a novel gait rehabilitation method that uses a hybrid system comprising a powered ankle-foot orthosis (PAFO) and FES, and presents its coordination control. The developed system provides assistance to the ankle joint in accordance with the degree of volitional participation of patients with post-stroke hemiplegia. The PAFO adopts the desired joint angle and impedance profile obtained from biomechanical simulation. The FES patterns of the tibialis anterior and soleus muscles are derived from predetermined electromyogram patterns of healthy individuals during gait and personalized stimulation parameters. The CNN-based estimation model predicts the volitional joint torque from the electromyogram of the patient, which is used to coordinate the contributions of the PAFO and FES. The effectiveness of the developed hybrid system was tested on healthy individuals during treadmill walking with and without considering the volitional muscle activity of the individual. The results showed that consideration of the volitional muscle activity significantly lowers the energy consumption by the PAFO and FES while providing adaptively assisted ankle motion depending on the volitional muscle activities of the individual. The proposed system has potential use as an assist-as-needed rehabilitation system, where it can improve the outcome of gait rehabilitation by inducing active patient participation depending on the stage of rehabilitation.

Standing Balance Control of a Bipedal Robot Based on Behavior Cloning.

Bipedal robots have gained increasing attention for their human-like mobility which allows them to work in various human-scale environments. However, their inherent instability makes it difficult to control their balance while they are physically interacting with the environment. This study proposes a novel balance controller for bipedal robots based on a behavior cloning model as one of the machine learning techniques. The behavior cloning model employs two deep neural networks (DNNs) trained on human-operated balancing data, so that the trained model can predict the desired wrench required to maintain the balance of the bipedal robot. Based on the prediction of the desired wrench, the joint torques for both legs are calculated using robot dynamics. The performance of the developed balance controller was validated with a bipedal lower-body robotic system through simulation and experimental tests by providing random perturbations in the frontal plane. The developed balance controller demonstrated superior performance with respect to resistance to balance loss compared to the conventional balance control method, while generating a smoother balancing movement for the robot.

Corrigendum: Haptic Glove Using Tendon-Driven Soft Robotic Mechanism.

[This corrects the article DOI: 10.3389/fbioe.2020.541105.].

Haptic Glove Using Tendon-Driven Soft Robotic Mechanism.

Recent advancements in virtual reality and augmented reality call for light-weight and compliant haptic interfaces to maximize the task-performance interactivity with the virtual or extended environment. Noting this, we propose a haptic glove using a tendon-driven compliant robotic mechanism. Our proposed interface can provide haptic feedback to two fingers of a user, an index finger and a thumb. It can provide both cutaneous and kinesthetic feedback to the fingers by using the tendon-driven system. Each actuator is paired with a force sensor to exert the desired tension accurately. In order to optimize the perception of the kinesthetic feedback, we propose a perception-based kinesthetic feedback distribution strategy. We experimentally measured the force perception weight for peripheral interphalangeal (PIP) and metacarpophalangeal (MCP) joints. We observed no significant difference in the force perception between the two joints. Then, based on the obtained weights, our proposed force distribution method calculates the force for each joint. We also evaluated the effect of additional cutaneous feedback to the kinesthetic feedback, on the force perception at the fingertip. The experimental result has shown that additional cutaneous feedback has significantly increased the sensitivity of the human perception. Finally, we evaluated our proposed system and force distribution algorithm by conducting a human subject test. The experimental result indicates that the availability of the cutaneous feedback significantly improved the perceived realism and acuity of the contact force.

Development of a Novel Robotic Rehabilitation System With Muscle-to-Muscle Interface.

In this study, we developed a novel robotic system with a muscle-to-muscle interface to enhance rehabilitation of post-stroke patients. The developed robotic rehabilitation system was designed to provide patients with stage appropriate physical rehabilitation exercise and muscular stimulation. Unlike the position-based control of conventional bimanual robotic therapies, the developed system stimulates the activities of the target muscles, as well as the joint movements of the paretic limb. The robot-assisted motion and the electrical stimulation on the muscles of the paretic side are controlled by on-line comparison of the motion and the muscle activities between the paretic and unaffected sides. With the developed system, the rehabilitation exercise can be customized and modulated depending on the patient's stage of motor recovery after stroke. The system can be operated in three different modes allowing both passive and active exercises. The effectiveness of the developed system was verified with healthy human subjects, where the subjects were paired to serve as the unaffected side and the paretic side of a hemiplegic patient.

Development of a subject-specific guide system for Low-Intensity Focused Ultrasound (LIFU) brain stimulation.

Low-Intensity Focused Ultrasound (LIFU) has recently been considered as a promising neuromodulation technique because it can noninvasively stimulate the brain with a high spatial resolution. As spatial resolution is improved, there is a growing demand for developing more accurate and convenient guide systems. Therefore, in the present study, we have developed and prototyped a 3D printed wearable subject-specific helmet for LIFU stimulation that is guaranteed to be accurate. The spatial relationship between the target position and the full-width at half-maximum (FWHM) of acoustic pressure of the transducer, i.e. focal volume, was compared using the conventional image-guided navigation system. According to the distribution of positional errors, the target position was located well within the focal volume.

Development of an end-effector device for loose body removal in hip arthroscopy.

This article describes a novel hand-operated end-effector device developed for loose body removal in hip arthroscopy. This sterilizable and reusable device incorporates a wire-ball joint mechanism that provides motion with 5 degrees of freedom. The design accounted for the following: (1) the diameter of the femoral head, (2) range of motion of the wrist joint of the operator, (3) ease of assembly of modular parts, and (4) material stiffness and durability. The developed device is composed of three parts: a pistol-shaped hand-held unit, forceps module, and end-effector module, all of which were constructed using polyamide-imide. Experiments were conducted to characterize the range of motion, pushing force, and lateral stiffness of the end-effector. Seven consulting surgeons evaluated the performance of the device in arthroscopic hip model and cadaveric studies in comparison with that of a conventional linear grasper. The experimental results show that the developed device can perform tasks that conventional linear graspers cannot. A specialized end-effector device was developed for hip arthroscopy where a high degree of stiffness is required. The end-effector module is interchangeable based on the required outer diameter, and it is also reusable after sterilization at high temperature.

Development of Gait Rehabilitation System Capable of Assisting Pelvic Movement of Normal Walking.

Gait rehabilitation training with robotic exoskeleton is drawing attention as a method for more advanced gait rehabilitation training. However, most of the rehabilitation robots are mainly focused on locomotion training in the sagittal plane. This study introduces a novel gait rehabilitation system with actuated pelvic motion to generate natural gait motion. The rehabilitation robot developed in this study, COWALK, is a lower-body exoskeleton system with 15 degrees of freedom (DoFs). The COWALK can generate multi-DoF pelvic movement along with leg movements. To produce natural gait patterns, the actuation of pelvic movement is essential. In the COWALK, the pelvic movement mechanism is designed to help hemiplegic patients regain gait balance during gait training. To verify the effectiveness of the developed system, the gait patterns with and without pelvic movement were compared to the normal gait on a treadmill. The experimental results show that the active control of pelvic movement combined with the active control of leg movement can make the gait pattern much more natural.

Endoscopic navigation system with extended field of view using augmented reality technology.

BACKGROUND: While endoscopic skull base surgery (ESBS) has emerged as an alternative surgical option, the limited field of view of the endoscope may lead to the surgeon's fatigue and discomfort. METHODS: The developed navigation system includes extended augmented reality (AR), which can provide an extended viewport to a conventional endoscopic view by overlaying 3D anatomical models generated from preoperative medical images onto endoscope images. To enhance the accuracy of the developed system, we adopted state-of-the-art endoscopic calibration and tracking techniques based on an optical tracking system. RESULTS: The mean spatial errors of AR was ~1 mm, which falls in the acceptable range of accuracy for ESBS. For the simulated surgical tasks with the developed system, the number and duration of error events were decreased. CONCLUSIONS: The results show that the human subject can perform the task more precisely and safely with the developed AR-based navigation system than with the conventional endoscopic system.

Development and preclinical trials of a wire-driven end effector device for frozen shoulder treatment.

Several different flexible end effectors have been developed to solve the problem of approaching the lesion in a minimally invasive surgery. In this paper, we developed a wire-driven end effector device to treat frozen shoulder. Since the device is for capsular release surgery, it has a suitable bend radius for the surgery. It is a cylindrical cannula that can fit various surgical tools and can be sterilized after use. The end effector is made of an elastic material called PAI (polyamide-imide) with its outer diameter and total length being 4 and 19 mm. It is controlled by wires that are connected to a motor. Through quantitative evaluation, we confirmed that the end effector can bend up to 90° in an upward or downward direction. Through qualitative evaluation, we confirmed that the device can easier access all regions of the glenoid in a shoulder model than conventional electrocautery. An experiment on a cadaver followed, which allowed us to discuss the real life performance, operation, and areas of improvement of the device with surgeons. From the experiments, we confirmed that our target region, the IGHL (inferior glenohumeral ligament), is within the reach of our device. The surgeon also evaluated that the control of the device caused no inconvenience.

Prediction of Driver's Intention of Lane Change by Augmenting Sensor Information Using Machine Learning Techniques.

Driver assistance systems have become a major safety feature of modern passenger vehicles. The advanced driver assistance system (ADAS) is one of the active safety systems to improve the vehicle control performance and, thus, the safety of the driver and the passengers. To use the ADAS for lane change control, rapid and correct detection of the driver's intention is essential. This study proposes a novel preprocessing algorithm for the ADAS to improve the accuracy in classifying the driver's intention for lane change by augmenting basic measurements from conventional on-board sensors. The information on the vehicle states and the road surface condition is augmented by using an artificial neural network (ANN) models, and the augmented information is fed to a support vector machine (SVM) to detect the driver's intention with high accuracy. The feasibility of the developed algorithm was tested through driving simulator experiments. The results show that the classification accuracy for the driver's intention can be improved by providing an SVM model with sufficient driving information augmented by using ANN models of vehicle dynamics.

Estimation of the spatial profile of neuromodulation and the temporal latency in motor responses induced by focused ultrasound brain stimulation.

This study investigates the spatial profile and the temporal latency of the brain stimulation induced by the transcranial application of pulsed focused ultrasound (FUS). The site of neuromodulation was detected using 2-deoxy-2-[¹8F]fluoro-D-glucose PET immediately after FUS sonication on the unilateral thalamic area of Sprague-Dawley rats. The latency of the stimulation was estimated by measuring the time taken from the onset of the stimulation of the appropriate brain motor area to the corresponding tail motor response. The brain area showing elevated glucose uptake from the PET image was much smaller (56±10% in diameter, 24±6% in length) than the size of the acoustic focus, which is conventionally defined by the full-width at half-maximum of the acoustic intensity field. The spatial dimension of the FUS-mediated neuromodulatory area was more localized, approximated to be full-width at 90%-maximum of the acoustic intensity field. In addition, the time delay of motor responses elicited by the FUS sonication was 171±63 (SD) ms from the onset of sonication. When compared with latencies of other nonultrasonic neurostimulation techniques, the longer time delay associated with FUS-mediated motor responses is suggestive of the nonelectrical modes of neuromodulation, making it a distinctive brain stimulation method.

Non-invasive brain-to-brain interface (BBI): establishing functional links between two brains.

Transcranial focused ultrasound (FUS) is capable of modulating the neural activity of specific brain regions, with a potential role as a non-invasive computer-to-brain interface (CBI). In conjunction with the use of brain-to-computer interface (BCI) techniques that translate brain function to generate computer commands, we investigated the feasibility of using the FUS-based CBI to non-invasively establish a functional link between the brains of different species (i.e. human and Sprague-Dawley rat), thus creating a brain-to-brain interface (BBI). The implementation was aimed to non-invasively translate the human volunteer's intention to stimulate a rat's brain motor area that is responsible for the tail movement. The volunteer initiated the intention by looking at a strobe light flicker on a computer display, and the degree of synchronization in the electroencephalographic steady-state-visual-evoked-potentials (SSVEP) with respect to the strobe frequency was analyzed using a computer. Increased signal amplitude in the SSVEP, indicating the volunteer's intention, triggered the delivery of a burst-mode FUS (350 kHz ultrasound frequency, tone burst duration of 0.5 ms, pulse repetition frequency of 1 kHz, given for 300 msec duration) to excite the motor area of an anesthetized rat transcranially. The successful excitation subsequently elicited the tail movement, which was detected by a motion sensor. The interface was achieved at 94.0±3.0% accuracy, with a time delay of 1.59±1.07 sec from the thought-initiation to the creation of the tail movement. Our results demonstrate the feasibility of a computer-mediated BBI that links central neural functions between two biological entities, which may confer unexplored opportunities in the study of neuroscience with potential implications for therapeutic applications.

Noninvasive transcranial stimulation of rat abducens nerve by focused ultrasound.

Nonpharmacologic and nonsurgical transcranial modulation of the nerve function may provide new opportunities in evaluation and treatment of cranial nerve diseases. This study investigates the possibility of using low-intensity transcranial focused ultrasound (FUS) to selectively stimulate the rat abducens nerve located above the base of the skull. FUS (frequencies of 350 kHz and 650 kHz) operating in a pulsed mode was applied to the abducens nerve of Sprague-Dawley rats under stereotactic guidance. The abductive eyeball movement ipsilateral to the side of sonication was observed at 350 kHz, using the 0.36-msec tone burst duration (TBD), 1.5-kHz pulse repetition frequency (PRF), and the overall sonication duration of 200 msec. Histologic and behavioral monitoring showed no signs of disruption in the blood brain barrier (BBB), as well as no damage to the nerves and adjacent brain tissue resulting from the sonication. As a novel functional neuro-modulatory modality, the pulsed application of FUS has potential for diagnostic and therapeutic applications in diseases of the peripheral nervous system.

Transcranial focused ultrasound to the thalamus is associated with reduced extracellular GABA levels in rats.

OBJECTIVE: Transcranial focused ultrasound (FUS), with its ability to non-invasively modulate the excitability of region-specific brain areas, is gaining attention as a potential neurotherapeutic modality. The aim of this study was to examine whether or not FUS administered to the brain could alter the extracellular levels of glutamate and γ-aminobutyric acid (GABA), which are representative excitatory and inhibitory amino acid neurotransmitters, respectively. METHODS: FUS, delivered in the form of a train of pulses, was applied to the thalamus of Sprague-Dawley rats transcranially. Glutamate and GABA were directly sampled from the frontal lobe of the rat brain via a direct microdialysis technique before, during, and after the sonication. The dialysate concentrations were determined by high-performance liquid chromatography. RESULTS: The individual levels of the neurotransmitters sampled were normalized to the baseline level for each rat. In terms of the changes in extracellular glutamate levels, there was no difference between the FUS-treated group and the unsonicated control group. However, extracellular GABA levels started to decrease upon sonication and remained reduced (approximately 20% below baseline; repeated-measures ANOVA, p < 0.05, adjusted for multiple comparisons) compared to the control group. CONCLUSION: The ability to modulate region-specific brain activity, along with the present evidence of the ability to modulate neurotransmission, demonstrates the potential utility of FUS as a completely new non-invasive therapeutic modality.

Prediction of the rotational state of the humerus by comparing the contour of the contralateral bicipital groove: Method for intraoperative evaluation.

BACKGROUND: Accurate reduction of rotational displacement for transverse or comminute fracture of humeral shaft fracture is difficult during operation. The purpose of this study was to evaluate the reliability of the bicipital groove as a point of reference for the prediction of the rotational state of the humerus on two dimensional images of C-arm image intensifier during operation for humeral shaft fractures. MATERIALS AND METHODS: One hundred subjects, 62 male, 38 female, aged 22-53 years were recruited contralateral bicipital groove on the 45 degrees externally rotational standard anterior-posterior view recorded before surgery. Three observers, watched only contour of bicipital groove in monitor of C-arm image intensification with naked eye without looking at the subject and predicted rotational state of the humerus by comparing the contour of the opposite side of bicipital groove. The angle of discrepancy from real rotational position was then assessed. RESULTS: The mean (SD), angular discrepancy between the neutral point and the predicted angle was 3.4°(±2.7°). A value within 5° was present in 72% of cases. All observations were within 15°. There was no interobserver variation (P = 0.47). The intraclass correlation coefficient (ICC) was 0.847. CONCLUSION: Contour of the bicipital groove on simple radiograph was a useful landmark. Comparing the contour of the bicipital groove in the 45 degrees externally rotational standard view bilaterally, was an effective method for reduction of rotational displacement of the humerus.

Image-guided Navigation of Single-element Focused Ultrasound Transducer.

The spatial specificity and controllability of focused ultrasound (FUS), in addition to its ability to modify the excitability of neural tissue, allows for the selective and reversible neuromodulation of the brain function, with great potential in neurotherapeutics. Intra-operative magnetic resonance imaging (MRI) guidance (in short, MRg) has limitations due to its complicated examination logistics, such as fixation through skull screws to mount the stereotactic frame, simultaneous sonication in the MRI environment, and restrictions in choosing MR-compatible materials. In order to overcome these limitations, an image-guidance system based on optical tracking and pre-operative imaging data is developed, separating the imaging acquisition for guidance and sonication procedure for treatment. Techniques to define the local coordinates of the focal point of sonication are presented. First, mechanical calibration detects the concentric rotational motion of a rigid-body optical tracker, attached to a straight rod mimicking the sonication path, pivoted at the virtual FUS focus. The spatial error presented in the mechanical calibration was compensated further by MRI-based calibration, which estimates the spatial offset between the navigated focal point and the ground-truth location of the sonication focus obtained from a temperature-sensitive MR sequence. MRI-based calibration offered a significant decrease in spatial errors (1.9±0.8 mm; 57% reduction) compared to the mechanical calibration method alone (4.4±0.9 mm). Using the presented method, pulse-mode FUS was applied to the motor area of the rat brain, and successfully stimulated the motor cortex. The presented techniques can be readily adapted for the transcranial application of FUS to intact human brain.

Transcranial focused ultrasound to the thalamus alters anesthesia time in rats.

A pulsed application of focused ultrasound (FUS) to the regional brain tissue alters the state of tissue excitability and thus provides the means for noninvasive functional neuromodulation. We report that the application of transcranial FUS to the thalamus of anesthetized rats reduced the time to emergence of voluntary movement from intraperitoneal ketamine/xylazine anesthesia. Low-intensity FUS was applied to the thalamus of anesthetized animals. The times required for the animals to show distinct physiological/behavioral changes were measured and compared with those times required in a control session without sonication. The sonication significantly reduced the time to show pinch response and voluntary movement. The modulatory effects of FUS on anesthesia suggest potential therapeutic applications for disorders of consciousness such as minimally consciousness states.

Impedance learning for robotic contact tasks using natural actor-critic algorithm.

Compared with their robotic counterparts, humans excel at various tasks by using their ability to adaptively modulate arm impedance parameters. This ability allows us to successfully perform contact tasks even in uncertain environments. This paper considers a learning strategy of motor skill for robotic contact tasks based on a human motor control theory and machine learning schemes. Our robot learning method employs impedance control based on the equilibrium point control theory and reinforcement learning to determine the impedance parameters for contact tasks. A recursive least-square filter-based episodic natural actor-critic algorithm is used to find the optimal impedance parameters. The effectiveness of the proposed method was tested through dynamic simulations of various contact tasks. The simulation results demonstrated that the proposed method optimizes the performance of the contact tasks in uncertain conditions of the environment.

Estimation of carrying angle based on CT images in preoperative surgical planning for cubitus deformities.

Conventionally, the carrying angle of the elbow is measured using simple two-dimensional radiography or goniometry, which has questionable reliability. This study proposes a novel method for estimating carrying angles using computed tomography that can enhance the reliability of the angle measurement. Data of CT scans from 25 elbow joints were processed to build segmented three-dimensional models. The cross-sectional centerlines of the ulna and the humerus were traced from the 3D models, and the angle between 2 vectors formed from the centerlines of the humerus and the ulna was defined as the "three-dimensional carrying angle." These angles were compared with those measured by simple radiograph. Two cases of angular deformity were underwent surgery based on this preoperative surgical planning, and the postoperative 3D carrying angles were evaluated using the proposed method. The mean value of the calculated three-dimensional carrying angle was 20.7 degrees +/-3.61, while it was 16.3 degrees +/-3.21 based on simple radiography without statistical difference. Based on the 3D carrying angle estimations, 2 surgical cases of cubitus deformities were planned by comparison with the normal contra-lateral elbow. Postoperative angle estimations confirmed that the corrected angles were nearly identical to the planned angles for both cases. The results of this study showed that the carrying angle can be accurately estimated using three-dimensional CT and that the proposed method is useful in evaluating deformities of the elbow with high reliability.