Field Of Neurorehabilitation Research Articles

Comment on Chow, J.W.; Stokic, D.S. Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke. Brain Sci. 2021, 11, 1648.

The field of neurorehabilitation has moved considerably beyond a narrow use of gait speed [...].

A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review.

Spinal cord injury (SCI) has been associated with high mortality rates. Thanks to the multidisciplinary vision and approach of SCI, including the application of new technologies in the field of neurorehabilitation, people with SCI can survive and prosper after injury. The main aim of this systematic review was to analyze the effectiveness of the combined use of VR and robotics in the treatment of patients with SCI. The literature search was performed between May and July 2021 in the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, and Web of Science. The methodological quality of each study was assessed using the SCIRE system and the PEDro scale, whereas the risk of bias was analyzed using the Cochrane Collaboration’s tool. A total of six studies, involving 63 participants, were included in this systematic review. Relevant changes were found in the upper limbs, with improvements of shoulder and upper arm mobility, as well as the strengthening of weaker muscles. Combined rehabilitation may be a valuable approach to improve motor function in SCI patients. Nonetheless, further research is necessary, with a larger patient sample and a longer duration.

In vivo peripheral nerve activation using sinusoidal low-frequency alternating currents.

The sinusoidal low-frequency alternating current (LFAC) waveform was explored recently as a novel means to evoke nerve conduction block. In the present work, we explored whether increasing the amplitude of the LFAC waveform results in nerve fiber activation in autonomic nerves. In-silico methods and preliminary work in somatic nerves indicated a potential frequency dependency on the threshold of activation. The Hering-Breuer (HB) reflex was used as a biomarker to detect cervical vagus nerve activation. Experiments were conducted in isoflurane-anesthetized swine (n=5). Two stimulating bipolar cuff electrodes and a tripolar recording cuff electrode were implanted on the left vagus nerve. To ensure the electrical stimulation affects only the afferent pathways, the nerve was crushed caudal to the electrodes to eliminate cardiac effects. (1) Standard pulse stimulation (Vstim) using a monophasic train of pulses was applied through the caudal electrode to elicit HB reflex and to identify the activated nerve fiber type. (2) Continuous sinusoidal LFAC waveform with a frequency ranging from 5 through 20 Hz was applied to the rostral electrode without Vstim to explore the activation thresholds at each LFAC frequency. In both cases, the activation of nerve fibers was detected by a HB reflex-induced reduction in the breathing rate. LFAC was found to be capable of eliciting an HB response. The LFAC activation thresholds were found to be frequency-dependent. The HB threshold was 1.02 ± 0.3 mAp at 5Hz, 0.66 ± 0.3 mAp at 10Hz, and 0.44 ± 0.2 mAp at 20 Hz. In comparison, it was 0.7 ± 0.47 mA for a 100 μs pulse. The LFAC amplitude was within the linear limits of the electrode interface. Damage to the cuff electrodes or the nerve tissues was not observed. Analysis of Vstim-based compound nerve action potentials (CNAP) indicated that the decrease in breathing rate was found to be correlated with the activation of slower components of the CNAP suggesting that LFAC reached and elicited responses from these slower fibers associated with afferents projecting to the HB response. These results suggest the feasibility of the LFAC waveform at 5, 10, and 20 Hz to activate autonomic nerve fibers and potentially provide a new modality to the neurorehabilitation field.

Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury.

ObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).MethodsTen subjects (eight males, 20–69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).ResultsContinuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold p =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.ConclusionIncreased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation.

The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: A scoping review

ObjectiveSurface electromyography (sEMG) is a common electrophysiological assessment used in clinical trials in individuals with spinal cord injury (SCI). This scoping review summarizes the most common sEMG techniques used to address clinically relevant neurorehabilitation questions. We focused on the role of sEMG assessments in the clinical practice and research studies on neurorehabilitation after SCI, and how sEMG reflects the changes observed with rehabilitation. Additionally, this review emphasizes the limitations and pitfalls of the sEMG assessments in the field of neurorehabilitation after SCI. MethodsA comprehensive search of Medline (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Emcare, Cumulative Index to Nursing & Allied Health Literature, and PubMed was conducted to find peer-reviewed journal articles that included individuals post-SCI that participated in neurorehabilitation interventions using sEMG assessments. This is a scoping review using a systematic search (hybrid review). ResultsOf 4522 references captured in the primary database searches, 100 references were selected and included in the scoping review. The main focus of the studies was on neurorehabilitation using sEMG biofeedback, brain stimulation, locomotor training, neuromuscular electrical stimulation (NMES), paired-pulse stimulation, pharmacology, posture and balance training, spinal cord stimulation, upper limb training, vibration, and photobiomodulation. ConclusionsMost studies employed sEMG amplitude to understand the effects of neurorehabilitation on muscle activation during volitional efforts or reduction of spontaneous muscle activity (e.g., spasms, spasticity, and hypertonia). Further studies are needed to understand the long-term reliability of sEMG amplitude, to circumvent normalization issues, and to provide a deeper physiological background to the different sEMG analyses. SignificanceThis scoping review reveals the potential of sEMG in exploring promising neurorehabilitation strategies following SCI and discusses the barriers limiting its widespread use in the clinic.

Multiscale time-frequency method for multiclass Motor Imagery Brain Computer Interface

Motor Imagery Brain Computer Interface (MI-BCI) has become a promising technology in the field of neurorehabilitation. However, the performance and computational complexity of the current multiclass MI-BCI have not been fully optimized, and the intuitive interpretation of individual differences on motor imagery tasks is seldom investigated. In this paper, a well-designed multiscale time-frequency segmentation scheme is first applied to multichannel EEG recordings to obtain Time-Frequency Segments (TFSs). Then, the TFS selection based on a specific wrapper feature selection rule is utilized to determine optimum TFSs. Next, One-Versus-One (OvO)-divCSP implemented in divergence framework is used to extract discriminative features. Finally, One-Versus-Rest (OvR)-SVM is utilized to predict the class label based on selected multiclass MI features. Experimental results indicate our method yields a superior performance on two publicly available multiclass MI datasets with a mean accuracy of 80.00% and a mean kappa of 0.73. Meanwhile, the proposed TFS selection method can significantly alleviate the computational burden with little accuracy reduction, demonstrating the feasibility of real-time multiclass MI-BCI. Furthermore, the Motor Imagery Time-Frequency Reaction Map (MI-TFRM) is visualized, contributing to analyzing and interpreting the performance differences between different subjects.

A Review Regarding Neurorehabilitation Technologies for Hand Motor Functions

The paper deals with a short review regarding neurorehabilitation technologies for regaining human hand mobility functions after a cerebrovascular accident or stroke. The aim of this paper is to form a general understanding of the current technologies used in the field of neurorehabilitation and highlight key characteristics, advantages and disadvantages. Technologies that are studies include robot exoskeletons, electro stimulation, brain computer interfaces (BCI), EEG and limb mounted sensors. After a presenting a summary of current existing technologies, a brief conclusion proposing the future direction of this study is proposed.

The Role of Baseline Functional MRI as a Predictor of Post-Stroke Rehabilitation Efficacy in Patients with Moderate to Severe Upper Extremity Dysfunction

Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field. Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy. Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.

Development and Validation of a Graded Motor Imagery Intervention for Phantom Limb Pain in Patients with Amputations (GraMI Protocol): A Delphi Study.

Background: Phantom limb pain can be defined as discomfort or pain in a missing part of the limb. The aims of this study were to develop and validate, through a Delphi methodology, a graded motor imagery protocol in order to reduce phantom limb pain. Method: Physiotherapists and/or occupational therapists with experience in research and a minimum clinical experience of five years in the field of neurorehabilitation and/or pain were recruited by part of a group of experts to assess the intervention. The study was conducted through an online questionnaire, where experts assessed each aspect of the intervention through a Likert scale. As many rounds as necessary were carried out until consensus was reached among experts. Results: A total of two rounds were required to fully validate the intervention. During the second round, the relative interquartile range of all aspects to be assessed was less than 15%, thus showing a consensus among experts and with good concordance (Kappa index of 0.76). Conclusion: Experts validated a graded motor imagery intervention of phantom limb pain in patients with amputations (GraMi protocol). This intervention can help to homogenize the use of graded motor imagery in future studies and in clinical practice.

Individualized beta-band oscillatory transcranial direct current stimulation over the primary motor cortex enhances corticomuscular coherence and corticospinal excitability in healthy individuals

BackgroundSimultaneously modulating individual neural oscillation and cortical excitability may be important for enhancing communication between the primary motor cortex and spinal motor neurons, which plays a key role in motor control. However, it is unknown whether individualized beta-band oscillatory transcranial direct current stimulation (otDCS) enhances corticospinal oscillation and excitability. ObjectiveThis study investigated the effects of individualized beta-band otDCS on corticomuscular coherence (CMC) and corticospinal excitability in healthy individuals. MethodsIn total, 29 healthy volunteers participated in separate experiments. They received the following stimuli for 10 min on different days: 1) 2-mA otDCS with individualized beta-band frequencies, 2) 2-mA transcranial alternating current stimulation (tACS) with individualized beta-band frequencies, and 3) 2-mA transcranial direct current stimulation (tDCS). The changes in CMC between the vertex and tibialis anterior (TA) muscle and TA muscle motor-evoked potentials (MEPs) were assessed before and after (immediately, 10 min, and 20 min after) stimulation on different days. Additionally, 20-Hz otDCS for 10 min was applied to investigate the effects of a fixed beta-band frequency on CMC. ResultsotDCS significantly increased CMC and MEPs immediately after stimulation, whereas tACS and tDCS had no effects. There was a significant negative correlation between normalized CMC changes in response to 20-Hz otDCS and the numerical difference between the 20-Hz and individualized CMC peak frequency before the stimulation. ConclusionsThese findings suggest that simultaneous modulation of neural oscillation and cortical excitability is critical for enhancing corticospinal communication. Individualized otDCS holds potential as a useful method in the field of neurorehabilitation.

Protocol of Non-invasive Current Stimulation in Acute Posterior-circulation Stroke with High Risk for Falling (NAPS trial): A Randomized Double-blind Sham-controlled Study

Abstract Background: Posterior-circulation stroke accounts for approximately 20∼30% of all ischemic stroke. It can manifest as symptoms with a variety of headache, nausea, diplopia, ataxia and gait disturbance. Among them, imbalance and gait problem are main symptoms that can induce a difficulty for living daily life and a high risk for falling in these patients. In many neurological diseases including stroke and cerebellar ataxia, a therapeutic approach to imbalance and gait problem through brain stimulation has received much attention at neurorehabilitation field. However, there has been no such effort focusing on acute posterior-circulation stroke patients with imbalance and/or gait problem. Our study’s aim is to investigate the effect of non-invasive repetitive transcranial direct current stimulation (tDCS) of cerebellum on improving balance/gait control in acute posterior-circulation stroke patients with imbalance or gait problem. Methods: Acute posterior-circulation stroke patients who were admitted within 5 days of symptom onset and at high risk for falling due to imbalance and/or gait problem, were recruited and randomized into two groups: intervention (tDCS stimulation) and control (sham stimulation) groups. Intervention group will receive 10 daily sessions of tDCS for 2 weeks (2 mA for 20 min). Outcome measurement was performed at baseline, after 2 weeks (the end of stimulation), and 4 weeks. Primary outcome was mean difference of Performance-oriented assessment of mobility (POMA) total score (baseline - 4 weeks) between the two groups. Secondary outcomes were difference of the balance and gait score of POMA, Dizziness Handicap Inventory (DHI), Falls Self-Efficiency Scale (FES-I), Beck Depression Invention (BDI), Beck Anxiety Inventory (BAI) and gait analysis. Conclusion: Our study focuses on the acute-stage (<1 week of symptom onset) and more specific symptoms in posterior-circulation stroke patients to improve the clinical outcome and quality of life in those and prove the effect of early tDCS intervention. Keywords: Transcranial direct current stimulation, Acute stroke, Posterior-circulation, Outcome

Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke : a systematic review.

Stroke is the most common cause of disability in Western Countries. It can lead to loss of mobility, capability to walk and ultimately loss of independence in activities of daily living (ADL). Several rehabilitative approaches have been proposed in these years. Robot-assisted gait rehabilitation (RAGT) plays a crucial role to perform a repetitive, intensive, and task-oriented treatment in stroke survivors. However, there are still few data on its role in subacute stroke patients. The aim of the present study was to assess the efficacy of RAGT for gait recovery in subacute stroke survivors. Systematic review with meta-analysis. The setting of the study included Units of Rehabilitation. The analyzed population was represented by subacute stroke patients. PubMed, Scopus, Web of Science, CENTRAL, and PEDro were systematically searched until January 18, 2021, to identify randomized controlled trials (RCTs) presenting: stroke survivors in subacute phase (≤6 months) as participants; exoskeleton robots devices as intervention; conventional rehabilitation as a comparator; gait assessment, through qualitative scales, quantitative gait scales or quantitative parameters, as outcome measures. We also performed a meta-analysis of the mean difference in the functional ambulation category (FAC) via the random effect method. Out of 3188 records, 14 RCTs were analyzed in this systematic review. The 14 studies have been published in the last 14 years (from 2006 to 2021) and included 576 stroke survivors, of which 306 received RAGT, and 270 underwent conventional rehabilitation. Lokomat robotic system was the most investigated robotic exoskeleton by the RCTs included (N.=9), albeit the meta-analysis demonstrated a non-significant difference of -0.09 in FAC (95% CI: -0.22.0.03) between Lokomat and conventional therapy. According to the PEDro scale, 11 (78.5%) were classified as good-quality studies, two as fair-quality studies (14.3%), and one as poor-quality study (7.1%). Taken together, these findings showed that RAGT might have a potential role in gait recovery in subacute stroke survivors. However, further RCTs comparing the efficacy of RAGT with conventional physical therapy are still warranted in the neurorehabilitation field. This systematic review provides information on the efficacy of RAGT in allowing subacute stroke patients to perform high-intensity gait training with a lower physical burden on PRM professionals.

Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review.

Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

What Do We Know about The Use of Virtual Reality in the Rehabilitation Field? A Brief Overview

Over the past two decades, virtual reality technology (VRT)-based rehabilitation has been increasingly examined and applied to assist patient recovery in the physical and cognitive domains. The advantages of the use of VRT in the neurorehabilitation field consist of the possibility of training an impaired function as a way to stimulate neuron reorganization (to maximize motor learning and neuroplasticity) and restoring and regaining functions and abilities by interacting with a safe and nonthreatening yet realistic virtual reality environment (VRE). Furthermore, VREs can be tailored to patient needs and provide personalized feedback on performance. VREs may also support cognitive training and increases patient motivation and enjoyment. Despite these potential advantages, there are inconclusive data about the usefulness of VRT in neurorehabilitation settings, and some issues on feasibility and safety remain to be ascertained for some neurological populations. The present brief overview aims to summarize the available literature on VRT applications in neurorehabilitation settings, along with discussing the pros and cons of VR and introducing the practical issues for research. The available studies on VRT for rehabilitation purposes over the past two decades have been mostly preliminary and feature small sample sizes. Furthermore, the studies dealing with VRT as an assessment method are more numerous than those harnessing VRT as a training method; however, the reviewed studies show the great potential of VRT in rehabilitation. A broad application of VRT is foreseeable in the near future due to the increasing availability of low-cost VR devices and the possibility of personalizing VR settings and the use of VR at home, thus actively contributing to reducing healthcare costs and improving rehabilitation outcomes.

Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic.

Background: Corona virus disease (COVID-19) was declared a pandemic by the World Health Organization in March 2020. This has affected service delivery among all medical disciplines in India including neurorehabilitation services.Aims and Objectives: The aims and objectives of the study were to assess the effect of COVID-19 pandemic on neurorehabilitation services across India.Methodology: A prospective nationwide survey study was undertaken by the Indian Federation of Neurorehabilitation during the pandemic. A questionnaire was prepared using Google forms software consisting of four sections: demography, neurorehabilitation practice before COVID-19 pandemic, neurorehabilitation practice during COVID-19 pandemic, and continuing medical education during COVID-19 pandemic.Results: Responses (872) were received from neurorehabilitation professionals across the country out of which 2.2% professionals did not give consent for participating in the survey. Participants (36.6%) were practicing traditional or independent referral basis rehabilitation, while 63.4% participants were practicing multidisciplinary rehabilitation. On an average, respective units were conducting 500–750 therapy sessions per month. Majority of the rehabilitation units in India lacked a physiatrist, rehabilitation nurse, music therapist, cognitive therapist, and urologist. Approximately 80% of the rehabilitation units have the basic rehabilitation modalities and advance technology was present in only 20% of the rehabilitation units. During COVID-19 pandemic, 19.5% centers were providing elective services, 50.3% emergency services, 15.6% new outpatient services, and 22.7% were providing follow-up outpatient services. Centers (51.5%) were providing telerehabilitation services for neurological conditions during the times of COVID-19 pandemic. Professionals (61.1%) providing telerehabilitation were working from home. Among the patients who needed neurorehabilitation, 28% were doing their exercises independently, 31% were supervised by caregivers, 17% were supervised by therapists, and 24% were not receiving any therapy. Participants (95.5%) wanted to receive more training in the field of neurorehabilitation. The participants utilized webinars (71%), online courses (22%), case discussion forums (19%), panel discussions (13%), and literature search (8%) during COVID-19 pandemic to continue education.Conclusion: The study reflects the situation of neurorehabilitation service delivery in India during the pandemic as the respondents were from all parts of the country and included most components of the neurorehabilitation team. Neurorehabilitation services were severely affected across India during the COVID-19 pandemic. Tele-neurorehabilitation has emerged as a new service delivery model during the pandemic. Online means of education has emerged as the primary source of continuing medical education during the pandemic.

Specific Brain Reorganization Underlying Superior Upper Limb Motor Function After Spinal Cord Injury: A Multimodal MRI Study

Background We recently discovered that individuals with complete spinal cord injury (SCI) have a higher grip force control ability in their intact upper limbs than able-bodied subjects. However, the neural basis for this phenomenon is unknown. Objective This study aimed to investigate the neural basis of the higher grip force control in the brains of individuals with SCI using multimodal magnetic resonance imaging (MRI). Methods Eight SCI subjects and 10 able-bodied subjects performed hand grip force control tasks at 10%, 20%, and 30% of their maximal voluntary contraction during functional MRI (fMRI). Resting-state fMRI and T1-weighted structural images were obtained to investigate changes in brain networks and structures after SCI. Results SCI subjects showed higher grip force steadiness than able-bodied subjects (P < .05, corrected), smaller activation in the primary motor cortex (P < .05, corrected), and deactivation of the visual cortex (P < .001, uncorrected). Furthermore, SCI subjects had stronger functional connectivity between the superior parietal lobule and the left primary motor cortex (P < .001, uncorrected), as well as larger gray matter volume in the bilateral superior parietal lobule (P < .001, uncorrected). Conclusions The structural and functional reorganization observed in the superior parietal lobule of SCI subjects may represent the neural basis underlying the observed higher grip force control, and is likely responsible for the smaller activation in the primary motor cortex observed in these individuals. These findings could have applications in the fields of neurorehabilitation for improvement of intact limb functions after SCI.

Optimal design of motor learning experiments informed by Monte-Carlo simulation

In our field of neuro-rehabilitation, it is often difficult to have patients endure a long session of training, and we seek an estimate of minimum practice trials. In such cases, motor learning mea...

Fuzzy support vector machine with joint optimization of genetic algorithm and fuzzy c-means.

Motor imagery electroencephalogram (MI-EEG) play an important role in the field of neurorehabilitation, and a fuzzy support vector machine (FSVM) is one of the most used classifiers. Specifically, a fuzzy c-means (FCM) algorithm was used to membership calculation to deal with the classification problems with outliers or noises. However, FCM is sensitive to its initial value and easily falls into local optima. The joint optimization of genetic algorithm (GA) and FCM is proposed to enhance robustness of fuzzy memberships to initial cluster centers, yielding an improved FSVM (GF-FSVM). The features of each channel of MI-EEG are extracted by the improved refined composite multivariate multiscale fuzzy entropy and fused to form a feature vector for a trial. Then, GA is employed to optimize the initial cluster center of FCM, and the fuzzy membership degrees are calculated through an iterative process and further applied to classify two-class MI-EEGs. Extensive experiments are conducted on two publicly available datasets, the average recognition accuracies achieve 99.89% and 98.81% and the corresponding kappa values are 0.9978 and 0.9762, respectively. The optimized cluster centers of FCM via GA are almost overlapping, showing great stability, and GF-FSVM obtains higher classification accuracies and higher consistency as well.

RehabHand: Oriented-tasks serious games for upper limb rehabilitation by using Leap Motion Controller and target population in spinal cord injury

There is a growing interest in the use of technology in the field of neurorehabilitation in order to quantify and generate knowledge about sensorimotor disorders after neurological diseases, understanding that the technology has a high potential for its use as therapeutic tools. Taking into account that the rehabilitative process of motor disorders should extend beyond the inpatient condition, it's necessary to involve low-cost technology, in order to have technological solutions that can approach the outpatient period at home. to present the virtual applications-based RehabHand prototype for the rehabilitation of manipulative skills of the upper limbs in patients with neurological conditions and to determine the target population with respect to spinal cord injured patients. Seven virtual reality applications have been designed and developed with a therapeutic sense, manipulated by means of Leap Motion Controller. The target population was determined from a sample of 40 people, healthy and patients, analyzing hand movements and gestures. The hand movements and gestures were estimated with a fitting rate between the range 0.607-0.953, determining the target population by cervical levels and upper extremity motor score. Leap Motion is suitable for a determined sample of cervical patients with a rehabilitation purpose.

Safety of Transcranial Direct Current Stimulation in Neurorehabilitation.

Transcranial direct current stimulation (tDCS) has considerable potential as a useful method in the field of neurorehabilitation. However, the safety of tDCS for the human is primarily based on theoretical evidence related to electricity, and the safety information of applying tDCS to the human is only available from researcher's reporting. Based on tDCS studies with human and animal subjects and simulation-based studies of the safety of current stimulation in the past 20 years, this review investigated the safety of tDCS application to the human body. No severe complications have been reported in either adults or children for tDCS at an intensity of 4 mA or less, within a period of 60 minutes per day, using commonly applied 25 or 35 cm2 electrodes. According to animal studies, the amount of electricity used for tDCS is less than 5% of the amount that permanently changes brain tissue, thereby ensuring safety to a certain extent. In order to increase the efficacy of tDCS for neurorehabilitation and to minimize even trivial complications in the human screening of exclusion criteria should be conducted with detailed observations of complications.