arXiv subjects

An H. Do

Publications and source records attributed to An H. Do.

16 recordsLinked to original sources

arXiv2025

Prevalence of Upper Extremity Distal Predominant Weakness Pattern in Chronic Stroke

Background: Hemiparesis after subcortical stroke is classically described as distal upper-extremity (UE) predominant, but prevalence data in chronic stroke is limited. Objective: Determine the prevalence of distal predominant UE weakness in exclusively subcortical chronic stroke versus other stroke distributions, characterize cohort differences, and describe UE weakness patterns in chronic stroke overall. Methods: Outpatient records were retrospectively reviewed to identify chronic stroke subjects. Lesion locations were classified from radiographic reports as exclusively subcortical or not (using a whole brain and supratentorial definition). UE weakness was categorized as distal predominant or not. Prevalence was compared with $\chi$-squared testing and odds ratios (OR). Results: 250 subjects were included (mean 861 days post-stroke). Using the whole-brain definition, distal predominant weakness occurred in 30.6% of exclusively subcortical versus 17.4% of non-exclusively subcortical strokes (OR 2.09, 95% CI 1.15-3.81; p=0.014). Using the supratentorial definition, distal predominant weakness occurred in 27.9% versus 17.9%, respectively (OR 2.16, 95% CI 1.17-3.96; p=0.012). Across all chronic strokes, 60% had no UE weakness; distal predominant weakness was the most common weakness pattern (23%), followed by uniform UE weakness (12%); proximal predominant weakness was rare (3%). Conclusions: Distal predominant UE weakness is more prevalent in chronic exclusively subcortical stroke than in non-subcortical stroke. These prevalence estimates may help predict long-term outcomes based on lesion location, support rehabilitation planning, and aid clinical lesion localization and research prioritization.

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arXiv2025

Promoting arm movement practice with a novel wheelchair armrest early after stroke: A randomized controlled trial

Chronic upper extremity (UE) impairment is common after stroke. This study evaluated Boost, a novel wheelchair-mounted rehabilitation device designed to assist individuals in UE motor recovery during inpatient rehabilitation. Thirty-five stroke inpatients were randomized to perform additional UE exercises alongside standard therapy, using either Boost or a therapist-customized booklet for self-practice. Outcomes included the UE Fugl-Meyer (UEFM) Exam, Box and Block Test, Motor Activity Log, Modified Ashworth Scale, shoulder subluxation, and shoulder pain. At baseline, mean days post-stroke were 11.9$\pm$4.6 and 13.1$\pm$5.9, and UEFM scores were 20.5$\pm$10.1 and 21.0$\pm$13.5. Intervention durations averaged 11.9$\pm$4.0 and 17.2$\pm$8.8 days, respectively. Participants in the Boost group completed 3,359$\pm$3,137 additional arm movements. No significant between-group differences were found at the three-month follow-up. However, the Boost group showed a trend toward greater UEFM improvement immediately post-intervention (11.8 vs. 6.9 points, p=0.06). Importantly, UEFM gains were predicted by the number of Boost exercises performed (p=0.02, R-square=0.34). Subgroup analysis revealed that patients with less severe impairment (baseline UEFM >21) achieved significantly greater UEFM improvements at discharge with Boost compared to controls (15.8 vs. 7.8 points, p=0.01). These findings demonstrate the feasibility of achieving thousands of additional UE practice movements while seated in a wheelchair without direct supervision during subacute rehabilitation. The added movement practice was well tolerated and may offer short-term impairment-reduction benefits, particularly in those with less severe impairment. Larger trials are needed to confirm efficacy, establish optimal dosage, and determine long-term clinical and functional benefits of Boost-assisted therapy.

q-bio.NC↗

arXiv2025

Perception of Brain-Computer Interface Implantation Surgery for Motor, Sensory, and Autonomic Restoration in Spinal Cord Injury and Stroke

(Abridged) Stroke and SCI are conditions that can significantly impact the QoL of survivors in both the physical and psychosocial domains. Both diseases often result in significant motor and sensory impairments that are not fully reversible despite current available therapies. Invasive BCIs have emerged as a promising means to bypass the site of injury and potentially restore motor and sensory function. However, to maximize the utility and participant satisfaction with such technology, participants' willingness to embrace BCIs must be assessed, and placed in context with functional goals and rehabilitative priorities. Hence, we conducted a survey of a cohort of stroke (n=33), SCI (n=37), and both (n=1) participants regarding their receptiveness to invasive ECoG-based BCIs as well as to assess their goals for functional rehabilitation. Overall, participants indicated a high level of willingness to undergo surgery to implant ECoG grids for BCI technology if basic motor functions, including upper extremity, gait, bowel/bladder, and sensory function were restored. There was no correlation between participant willingness to undergo a prospective BCI implantation and the level of functional recovery offered by the BCI. Similarly, there was no correlation between willingness to undergo surgery and the participants' perceived rehabilitative priorities and level of disability. These findings indicate that participants were interested in invasive BCI technology even if only basic functions can be restored, regardless of their level of disability and their rehabilitative priorities. Such observations imply that first generation commercial invasive BCIs may not need extensive functions to garner adoption. Conversely, it also raises a concern that participants from the stroke and SCI cohort may be overly enthusiastic about such technology, which poses potential risks for medical exploitation.

cs.HC↗

arXiv2025

Leveraging Transfer Learning and User-Specific Updates for Rapid Training of BCI Decoders

Lengthy subject- or session-specific data acquisition and calibration remain a key barrier to deploying electroencephalography (EEG)-based brain-computer interfaces (BCIs) outside the laboratory. Previous work has shown that cross subject, cross-session invariant features exist in EEG. We propose a transfer learning pipeline based on a two-layer convolutional neural network (CNN) that leverages these invariants to reduce the burden of data acquisition and calibration. A baseline model is trained on EEG data from five able-bodied individuals and then rapidly updated with a small amount of data from a sixth, holdout subject. The remaining holdout data were used to test the performance of both the baseline and updated models. We repeated this procedure via a leave-one-subject out (LOSO) validation framework. Averaged over six LOSO folds, the updated model improved classification accuracy upon the baseline by 10.0, 18.8, and 22.1 percentage points on two binary and one ternary classification tasks, respectively. These results demonstrate that decoding accuracy can be substantially improved with minimal subject-specific data. They also indicate that a CNN-based decoder can be personalized rapidly, enabling near plug-and-play BCI functionality for neurorehabilitation and other time-critical EEG applications.

q-bio.QM↗

arXiv2025

Early Assessment of Artificial Lower Extremity Sensory Response Times and Proprioceptive Acuity via Sensory Cortex Electrical Stimulation

Bi-directional brain computer interfaces (BD-BCIs) may restore brain-controlled walking and artificial leg sensation after spinal cord injury. Current BD-BCIs provide only simplistic "tingling" feedback, which lacks proprioceptive information to perceive critical gait events (leg swing, double support). This information must also be perceived adequately fast to facilitate timely motor responses. Here, we investigated utilizing primary sensory cortex (S1) direct cortical electrical stimulation (DCES) to deliver leg proprioceptive information and measured response times to artificial leg sensations. Subjects with subdural electrocorticogram electrodes over S1 leg areas participated in two tasks: (1) Proprioceptive acuity: subjects identified the difference between DCES-induced percepts emulating various leg swing speeds; (2) Sensory response: measuring subjects' reaction time to DCES-induced leg sensations, with DCES-hand, visual and auditory control conditions. Three subjects were recruited. Only one completed the proprioceptive assessment, achieving 80%, 70%, 60%, and 53% accuracy in discriminating between fast/slow, fast/medium, medium/slow, and same speeds, respectively (p-value=1.9x10$^{-5}$). Response times for leg/hand percepts were 1007$\pm$413/599$\pm$171 ms, visual leg/hand responses were 528$\pm$137/384$\pm$84 ms, and auditory leg/hand responses were 393$\pm$106/352$\pm$93 ms, respectively. These results suggest proprioceptive information can be delivered artificially, but perception may be significantly delayed. Future work should address improving acuity, reducing response times, and expanding sensory modalities.

q-bio.NC↗

arXiv2025

Real-Time Brain-Computer Interface Control of Walking Exoskeleton with Bilateral Sensory Feedback

Invasive brain-computer interface (BCI) technology has demonstrated the possibility of restoring brain-controlled walking in paraplegic spinal cord injury patients. However, current implementations of BCI-controlled walking still have significant drawbacks. In particular, prior systems are unidirectional and lack sensory feedback for insensate patients, have suboptimal reliance on brain signals from the bilateral arm areas of the motor cortex, and depend on external systems for signal processing. Motivated by these shortcomings, this study is the first time a bidirectional brain-computer interface (BDBCI) has demonstrated the restoration of both brain-controlled walking and leg sensory feedback while utilizing the bilateral leg motor and sensory cortices. Here, a subject undergoing subdural electrocorticogram electrode implantation for epilepsy surgery evaluation leveraged the leg representation areas of the bilateral interhemispheric primary motor and sensory cortices to operate a BDBCI with high performance. Although electrode implantation in the interhemispheric region is uncommon, electrodes can be safely implanted in this region to access rich leg motor information and deliver bilateral leg sensory feedback. Finally, we demonstrated that all BDBCI operations can be executed on a dedicated, portable embedded system. These results indicate that BDBCIs can potentially provide brain-controlled ambulation and artificial leg sensation to people with paraplegia after spinal cord injury in a manner that emulates full-implantability and is untethered from any external systems.

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arXiv2024

Early feasibility of an embedded bi-directional brain-computer interface for ambulation

Current treatments for paraplegia induced by spinal cord injury (SCI) are often limited by the severity of the injury. The accompanying loss of sensory and motor functions often results in reliance on wheelchairs, which in turn causes reduced quality of life and increased risk of co-morbidities. While brain-computer interfaces (BCIs) for ambulation have shown promise in restoring or replacing lower extremity motor functions, none so far have simultaneously implemented sensory feedback functions. Additionally, many existing BCIs for ambulation rely on bulky external hardware that make them ill-suited for non-research settings. Here, we present an embedded bi-directional BCI (BDBCI), that restores motor function by enabling neural control over a robotic gait exoskeleton (RGE) and delivers sensory feedback via direct cortical electrical stimulation (DCES) in response to RGE leg swing. A first demonstration with this system was performed with a single subject implanted with electrocorticography electrodes, achieving an average lag-optimized cross-correlation of 0.80$\pm$0.08 between cues and decoded states over 5 runs.

q-bio.QM↗

arXiv2024

The weak relationship between ankle proprioception and gait speed after stroke a robotic assessment study

Ankle proprioceptive deficits are common after stroke and occur independently of ankle motor impairments. Despite this independence, some studies have found that ankle proprioceptive deficits predict gait function, consistent with the concept that somatosensory input plays a key role in gait control. Other studies, however, have not found a relationship, possibly because of variability in proprioception assessments. Robotic assessments of proprioception offer improved consistency and sensitivity. Here we relationships between ankle proprioception, ankle motor impairment, and gait function after stroke using robotic assessments of ankle proprioception. We quantified ankle proprioception using two different robotic tests (Joint Position Reproduction and Crisscross) in 39 persons in the chronic phase of stroke. We analyzed the extent to which these robotic proprioception measures predicted gait speed, measured over a long distance (6-minute walk test) and a short distance (10-meter walk test). We also studied the relationship between robotic proprioception measures and lower extremity motor impairment, quantified with measures of ankle strength, active range of motion, and the lower extremity Fugl-Meyer exam. Impairment in ankle proprioception was present in 87% of the participants. Ankle proprioceptive acuity measured with JPR was weakly correlated with 6MWT gait speed (\r{ho} = -0.34, p = 0.039) but not 10mWT (\r{ho} = -0.29, p = 0.08). Ankle proprioceptive acuity was not correlated with lower extremity motor impairment (p > 0.2). These results confirm the presence of a weak relationship between ankle proprioception and gait after stroke that is independent of motor impairment.

cs.RO↗

arXiv2021

Decoding of the Walking States and Step Rates from Cortical Electrocorticogram Signals

Brain-computer interfaces (BCIs) have shown promising results in restoring motor function to individuals with spinal cord injury. These systems have traditionally focused on the restoration of upper extremity function; however, the lower extremities have received relatively little attention. Early feasibility studies used noninvasive electroencephalogram (EEG)-based BCIs to restore walking function to people with paraplegia. However, the limited spatiotemporal resolution of EEG signals restricted the application of these BCIs to elementary gait tasks, such as the initiation and termination of walking. To restore more complex gait functions, BCIs must accurately decode additional degrees of freedom from brain signals. In this study, we used subdurally recorded electrocorticogram (ECoG) signals from able-bodied subjects to design a decoder capable of predicting the walking state and step rate information. We recorded ECoG signals from the motor cortices of two individuals as they walked on a treadmill at different speeds. Our offline analysis demonstrated that the state information could be decoded from >16 minutes of ECoG data with an unprecedented accuracy of 99.8%. Additionally, using a Bayesian filter approach, we achieved an average correlation coefficient between the decoded and true step rates of 0.934. When combined, these decoders may yield decoding accuracies sufficient to safely operate present-day walking prostheses.

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arXiv2020

Electromyogram (EMG) Removal by Adding Sources of EMG (ERASE) -- A novel ICA-based algorithm for removing myoelectric artifacts from EEG -- Part 2

Extraction of the movement-related high-gamma (80 - 160 Hz) in electroencephalogram (EEG) from traumatic brain injury (TBI) patients who have had hemicraniectomies, remains challenging due to a confounding bandwidth overlap with surface electromyogram (EMG) artifacts related to facial and head movements. In part 1, we described an augmented independent component analysis (ICA) approach for removal of EMG artifacts from EEG, and referred to as EMG Reduction by Adding Sources of EMG (ERASE). Here, we tested ERASE on EEG recorded from six TBI patients with hemicraniectomies while they performed a thumb flexion task. ERASE removed a mean of 52 +/- 12% (mean +/- S.E.M) (maximum 73%) of EMG artifacts. In contrast, conventional ICA removed a mean of 27 +/- 19\% (mean +/- S.E.M) of EMG artifacts from EEG. In particular, high-gamma synchronization was significantly improved in the contralateral hand motor cortex area within the hemicraniectomy site after ERASE was applied. We computed fractal dimension (FD) of EEG high-gamma on each channel. We found relative FD of high-gamma over hemicraniectomy after applying ERASE were strongly correlated to the amplitude of finger flexion force. Results showed that significant correlation coefficients across the electrodes related to thumb flexion averaged 0.76, while the coefficients across the homologous electrodes in non-hemicraniectomy areas were nearly 0. Across all subjects, an average of 83% of electrodes significantly correlated with force was located in the hemicraniectomy areas after applying ERASE. After conventional ICA, only 19% of electrodes with significant correlations were located in the hemicraniectomy. These results indicated that the new approach isolated electrophysiological features during finger motor activation while selectively removing confounding EMG artifacts.

eess.SP↗

arXiv2020

Electromyogram (EMG) Removal by Adding Sources of EMG (ERASE) -- A novel ICA-based algorithm for removing myoelectric artifacts from EEG -- Part 1

Electroencephalographic (EEG) recordings are often contaminated by electromyographic (EMG) artifacts, especially when recording during movement. Existing methods to remove EMG artifacts include independent component analysis (ICA), and other high-order statistical methods. However, these methods can not effectively remove most of EMG artifacts. Here, we proposed a modified ICA model for EMG artifacts removal in the EEG, which is called EMG Removal by Adding Sources of EMG (ERASE). In this new approach, additional channels of real EMG from neck and head muscles (reference artifacts) were added as inputs to ICA in order to "force" the most power from EMG artifacts into a few independent components (ICs). The ICs containing EMG artifacts (the "artifact ICs") were identified and rejected using an automated procedure. Simulation results showed ERASE removed EMG artifacts from EEG significantly more effectively than conventional ICA. Subsequently, EEG was collected from 8 healthy participants while they moved their hands to test the realistic efficacy of this approach. Results showed that ERASE successfully removed EMG artifacts (on average, about 75% of EMG artifacts were removed when using real EMGs as reference artifacts) while preserving the expected EEG features related to movement. We also tested the ERASE procedure using simulated EMGs as reference artifacts (about 63% of EMG artifacts removed). Compared to conventional ICA, ERASE removed on average 26% more EMG artifacts from EEG. These results indicate that using additional real or simulated EMG sources can increase the effectiveness of ICA in removing EMG artifacts from EEG. Combined with automated artifact IC rejection, ERASE also minimizes potential user bias.

eess.SP↗

arXiv2014

Electrocorticogram encoding of upper extremity movement trajectories

Electrocorticogram (ECoG)-based brain computer interfaces (BCI) can potentially control upper extremity prostheses to restore independent function to paralyzed individuals. However, current research is mostly restricted to the offline decoding of finger or 2D arm movement trajectories, and these results are modest. This study seeks to improve the fundamental understanding of the ECoG signal features underlying upper extremity movements to guide better BCI design. Subjects undergoing ECoG electrode implantation performed a series of elementary upper extremity movements in an intermittent flexion and extension manner. It was found that movement velocity, $\dotθ$, had a high positive (negative) correlation with the instantaneous power of the ECoG high-$γ$ band (80-160 Hz) during flexion (extension). Also, the correlation was low during idling epochs. Visual inspection of the ECoG high-$γ$ band revealed power bursts during flexion/extension events that have a waveform that strongly resembles the corresponding flexion/extension event as seen on $\dotθ$. These high-$γ$ bursts were present in all elementary movements, and were spatially distributed in a somatotopic fashion. Thus, it can be concluded that the high-$γ$ power of ECoG strongly encodes for movement trajectories, and can be used as an input feature in future BCIs.

q-bio.NC↗

arXiv2013

Brain-Computer Interface Controlled Robotic Gait Orthosis

Reliance on wheelchairs after spinal cord injury (SCI) leads to many medical co-morbidities. Treatment of these conditions contributes to the majority of SCI health care costs. Restoring able-body-like ambulation after SCI may reduce the incidence of these conditions, and increase independence and quality of life. However, no biomedical solution exists that can reverse this lost neurological function, and hence novel methods are needed. Brain-computer interface (BCI) controlled lower extremity prosthesis may constitute one such novel approach. One subject with able-body and one with paraplegia due to SCI underwent electroencephalogram (EEG) recording while engaged in alternating epochs of idling and walking kinesthetic motor imagery (KMI). These data were analyzed to generate an EEG prediction model for online BCI operation. A commercial robotic gait orthosis (RoGO) system (treadmill suspended), was interfaced with the BCI computer. In an online test, the subjects were tasked to ambulate using the BCI-RoGO system when prompted by computerized cues. The performance of this system was assessed with cross-correlation analysis, and omission and false alarm rates. The offline accuracy of the EEG prediction model averaged 86.3%. The cross-correlation between instructional cues and BCI-RoGO walking epochs averaged 0.812 +/- 0.048 (p-value<10^-4). There were on average 0.8 false alarms per session and no omissions. This is the first time a person with parapegia due to SCI regained basic brain-controlled ambulation, thereby indicating that restoring brain-controlled ambulation is feasible. Future work will test this system in a population of individuals with SCI. If successful, this may justify future development of invasive BCI-controlled lower extremity prostheses. This system may also be applied to incomplete SCI to improve neurological outcomes beyond those of standard physiotherapy.

cs.HC↗

arXiv2013

Pushing the Communication Speed Limit of a Noninvasive BCI Speller

Electroencephalogram (EEG) based brain-computer interfaces (BCI) may provide a means of communication for those affected by severe paralysis. However, the relatively low information transfer rates (ITR) of these systems, currently limited to 1 bit/sec, present a serious obstacle to their widespread adoption in both clinical and non-clinical applications. Here, we report on the development of a novel noninvasive BCI communication system that achieves ITRs that are severalfold higher than those previously reported with similar systems. Using only 8 EEG channels, 6 healthy subjects with little to no prior BCI experience selected characters from a virtual keyboard with sustained, error-free, online ITRs in excess of 3 bit/sec. By factoring in the time spent to notify the subjects of their selection, practical, error-free typing rates as high as 12.75 character/min were achieved, which allowed subjects to correctly type a 44-character sentence in less than 3.5 minutes. We hypothesize that ITRs can be further improved by optimizing the parameters of the interface, while practical typing rates can be significantly improved by shortening the selection notification time. These results provide compelling evidence that the ITR limit of noninvasive BCIs has not yet been reached and that further investigation into this matter is both justified and necessary.

cs.HC↗

arXiv2012

Operation of a Brain-Computer Interface Walking Simulator by Users with Spinal Cord Injury

Background: Spinal cord injury (SCI) can leave the affected individuals unable to ambulate. Since there are no restorative treatments for SCI, novel approaches such as brain-controlled prostheses have been sought. Our recent studies show that a brain-computer interface (BCI) can be used to control ambulation within a virtual reality environment (VRE), suggesting that a BCI-controlled lower extremity prosthesis for ambulation may be feasible. However, the operability of our BCI has not been tested in a SCI population. Methods: Five subjects with paraplegia or tetraplegia due to SCI underwent a 10-min training session in which they alternated between kinesthetic motor imagery (KMI) of idling and walking while their electroencephalogram (EEG) were recorded. Subjects then performed a goal-oriented online task, where they utilized KMI to control the linear ambulation of an avatar and make 10 sequential stops at designated points within the VRE. Multiple online trials were performed over 5 experimental days. Results: Classification accuracy of idling and walking was estimated offline and ranged from 60.5% (p=0.0176) to 92.3% (p=1.36*10^-20) across subjects and days. In the online task, all subjects achieved purposeful control with an average performance of 7.4 +/- 2.3 successful stops in 273 +/- 51 sec (p<0.01). All subjects maintained purposeful control throughout the study, and their online performances improved over time. Conclusions: The results demonstrate that SCI subjects can purposefully operate a self-paced BCI walking simulator to complete a goal-oriented ambulation task. The operation of this BCI system requires short training, is intuitive, and robust against subject-to-subject and day-to-day neurophysiological variations. These findings indicate that BCI-controlled lower extremity prostheses for gait rehabilitation or restoration after SCI may be feasible in the future.

cs.HC↗

arXiv2012

Self-paced brain-computer interface control of ambulation in a virtual reality environment

Objective: Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogramme (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach: Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over 5 sessions, in which they utilised the KMI to control the linear ambulation of an avatar and make 10 sequential stops at designated points within the VRE. Main results: The average offline training performance across subjects was 77.2 +/- 9.5%, ranging from 64.3% (p = 0.00176) to 94.5% (p = 6.26*10^-23), with chance performance being 50%. The average online performance was 8.4 +/- 1.0 (out of 10) successful stops and 303 +/- 53 sec completion time (perfect = 211 sec). All subjects achieved performances significantly different than those of random walk (p < 0.05) in 44 of the 45 online sessions. Significance: By using a data-driven machine learning approach to decode users' KMI, this BCIVRE system enabled intuitive and purposeful self-paced control of ambulation after only a 10-minute training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

cs.HC↗