Paralyzed Patients Research Articles

Apnoeic oxygenation and ventilation: go with the flow

Apnoeic oxygenation and ventilation: go with the flow

Stair-ascent strategies and performance evaluation for a lower limb exoskeleton

Power lower limb exoskeleton has gained considerable interests since it is widely applied in both walking assistance and rehabilitation related applications. The most challenge problem of these kinds lower exoskeletons is how to deal with the complex environment, such as stairs in daily life. Based on a developed lower limb exoskeleton named AssItive DEvice for paRalyzed patients (AIDER), this paper proposed a novel stair parameters perception approach named Stick From the Origin (SFO) and a bio-spired stair gait trajectory generator based on Dynamic Movement Primitives (DMPs) and summarized the joint torque and power requirements. With two distance sensors, the low-cost and real-time stair parameters perception approach could be tested and verified in practice with acceptable accuracy. During the process, the Center of Pressure (CoP) of the whole system would be concerned to keep the pilot’s safety. With the reference stair gait and stair parameters brought in, a natural and flexible stair-ascent gait can be generated by the bio-spired stair gait trajectory generator based on DMPs, which was validated in practical application on the AIDER system with and without pilot. Based on the averaged torques and power across these trials, the peak body-mass-normalized knee and hip joint power, knee and hip torque during the stair-ascent movement are 1.82 W/kg and 1.52 W/kg, 1.36 Nm/kg and 1.22 Nm/kg, which are required during the process of lifting the leg onto the stair tread.

Eye Blink Detection System for Paralyzed Patients

Paralysis of an human being is caused due to the degeneration of motor neurons which weakens the muscle, so that it does not allow patient to move, speak, breathe , and loss in the voluntary actions. It is an incurable disease. To understand the feelings of a paralyzed patients Brain wave technique and Electro-oculography techniques were used. These techniques are afflictive, discomfortable and leads to unconsciousness of the paralyzed patient. The real time video oculography system fills the communication gap between the patient and the world. Video Oculography (VOG) is video-based method of measuring the vertical, torsional and horizontal position components of both the eye blinks with the help of small cameras placed in the head-mounted mask .This paper presents different visual technologies, such as eye blink detection, eye center localization and conversion of the eye blink to speech. The video oculography could achieve accuracy of 0.968.

Neuropsychological and neurophysiological aspects of brain-computer-interface (BCI) control in paralysis.

Brain-computer interfaces (BCIs) aim to help paralysed patients to interact with their environment by controlling external devices using brain activity, thereby bypassing the dysfunctional motor system. Some neuronal disorders, such as amyotrophic lateral sclerosis (ALS), severely impair the communication capacity of patients. Several invasive and non-invasive brain-computer interfaces (BCIs), most notably using electroencephalography (EEG), have been developed to provide a means of communication to paralysed patients. However, except for a few reports, all available BCI literature for the paralysed (mostly ALS patients) describes patients with intact eye movement control, i.e. patients in a locked-in state (LIS) but not a completely locked-in state (CLIS). In this article we will discuss: (1) the fundamental neuropsychological learning factors and neurophysiological factors determining BCI performance in clinical applications; (2) the difference between LIS and CLIS; (3) recent development in BCIs for communication with patients in the completely locked-in state; (4) the effect of BCI-based communication on emotional well-being and quality of life; and (5) the outlook and the methodology needed to provide a means of communication for patients who have none. Thus, we present an overview of available studies and recent results and try to anticipate future developments which may open new doors for BCI communication with the completely paralysed.

830 Voice Activated Tool: A Successful Assistance for Patients with Limited Hand Function

Abstract Introduction Burn survivors require significant assistance in physical functions and independence during their recovery and rehabilitation phase. Amputation, splints, bulky dressings, and pain attribute to limited or lack of hand mobility. Voice activated tools (VAT) have rapidly grown in popularity including in healthcare. Prior to the implementation of this project, patients mostly depended on soft touch call lights which were suboptimal for most patients. We piloted VAT to assist in hand functions of patients with limited or lack of hand mobility. Methods The project was piloted in collaboration with IT, Occupational Therapy, Nursing, and patients’ family. IT enabled with uninterrupted source of wireless network connection in the patients’ room. Voice assistance was incorporated both through mobile phone and an added virtual assistant tool. Patients’ personal devices were used to promote utilization of stored information in the device. Occupational therapist assisted in mounting the device through a spring clamp and gooseneck cell phone holder to visualize the device screen. Speech therapists, nurses, and patient family helped in training the patient to voice appropriate commands. The patient utilized VAT for a wide variety of purposes including calling nurses, ordering hospital meals, phone calls, music, web browsing, and more. A survey was done to evaluate health care team’s opinion on VAT usage. Results Of the total burn team members, 34 (77%) staff responded to the survey including physicians, nurses, therapists, and nursing assistants. All survey responders reported VAT as a useful tool to be offered to all future patients with limited hand mobility. Majority (74%) of responders witnessed or participated in the successful use of VAT during the pilot period. Survey participants reported three reasons for the current soft touch call light system to be suboptimal: 1.Too sensitive, 2. Not all patients can use it 3. Conclusions Voice activated tool can be successfully utilized for assisting patients with limited hand mobility considering the current available tool is suboptimal. Adoption of a simple and popular technology of VAT can be easily incorporated in hospitals through collaboration of health care team. Applicability of Research to Practice Use of VAT could be successfully implemented for other hospital units including paralyzed patients, blind, and patients with orthopedic conditions or trauma to hands. Additionally, VAT could be incorporated in to rehabilitation and home training of patients with limited hand mobility. Further, VAT could be considered in the designing and planning of hospitals.

A Brain Computer Interface for Smart Home Control

A new communication channel called brain computer interface (BCI) which is between the brain of human and a digital computer. Its goal is to restore movements, restoring communication, restoring environmental control for disabled people. The natural communication and control is alternated using this system. The neuromuscular channels which are the efficient pathway of our human body are bypassed by BCI’s artificial system. The varying patterns which are produced due to neural interactions results in the different states of brain. The different patterns of waves having different ranges of frequencies and amplitudes are produced by the patterns of neural interaction which is performed by using multiple neurons. These interactions with the neurons lead to the electrical discharge in smaller ranges. This project deals with brain signals which are sensed by the sensor in the head. These signals are divided into packets of data which are then will be transmitted into a wireless medium such as Bluetooth. The unit which is measuring the brain wave will receive the raw data from the sensor and it is interfaced to microcontroller. The output data from the microcontroller is sent to the operation process in home section such as modules of bulb and fan. Depending on the alpha and theta wave amplitudes, the on, off condition of home appliances is varied. This helps in the easy operation of home electrical appliances for aged people and paralyzed patients. Since smart technologies are becoming very popular in recent times, this kind of application of smart technology in home control finds very useful and helpful.

SDN-Powered Humanoid With Edge Computing for Assisting Paralyzed Patients

The number of people afflicted with paralysis is increasing worldwide due to stroke, spinal cord injury, polio, and other related diseases. Exoskeletons have emerged as one of the promising technologies to provide assistance and rehabilitation for the paralyzed people. But most of the exoskeletons are limited by its bulkiness, lack of flexibility and stability, instant control and adaptability. To overcome these issues, this article proposes a novel and efficient software-defined network (SDN)-powered humanoid assistive and rehabilitation system. In the proposed system, the signals acquired by the human sensor module are processed with multiple node MCUs and transmitted via the SDN incorporated with universal software radio peripheral (USRP). Using edge computing, the signal from the USRP is sent to the receiver node MCU and is used for controlling the movements of the humanoid that provides assistance to the paralyzed patients. The experimental setup is done for controlling a humanoid hand, and the results show high quality-of-service (QoS) for hand roll-up and roll-down posture. QoS is also evaluated for different electroencephalogram (EEG) signals, and the results show that the SDN-enabled assistive humanoid system is an efficient method for providing instant control in rehabilitation of the paralyzed patients.

An Adaptive and Flexible Brain Energized Full Body Exoskeleton With IoT Edge for Assisting the Paralyzed Patients

The paralyzed population is increasing worldwide due to stroke, spinal code injury, post-polio, and other related diseases. Different assistive technologies are used to improve the physical and mental health of the affected patients. Exoskeletons have emerged as one of the most promising technology to provide movement and rehabilitation for the paralyzed. But exoskeletons are limited by the constraints of weight, flexibility, and adaptability. To resolve these issues, we propose an adaptive and flexible Brain Energized Full Body Exoskeleton (BFBE) for assisting the paralyzed people. This paper describes the design, control, and testing of BFBE with 15 degrees of freedom (DoF) for assisting the users in their daily activities. The flexibility is incorporated into the system by a modular design approach. The brain signals captured by the Electroencephalogram (EEG) sensors are used for controlling the movements of BFBE. The processing happens at the edge, reducing delay in decision making and the system is further integrated with an IoT module that helps to send an alert message to multiple caregivers in case of an emergency. The potential energy harvesting is used in the system to solve the power issues related to the exoskeleton. The stability in the gait cycle is ensured by using adaptive sensory feedback. The system validation is done by using six natural movements on ten different paralyzed persons. The system recognizes human intensions with an accuracy of 85%. The result shows that BFBE can be an efficient method for providing assistance and rehabilitation for paralyzed patients.

Chapter 22 - Merging brain-computer interface and functional electrical stimulation technologies for movement restoration

BCI (brain-computer interface) and functional electrical stimulation (FES) technologies have advanced significantly over the last several decades. Recent efforts have involved the integration of these technologies with the goal of restoring functional movement in paralyzed patients. Implantable BCIs have provided neural recordings with increased spatial resolution and have been combined with sophisticated neural decoding algorithms and increasingly capable FES systems to advance efforts toward this goal. This chapter reviews historical developments that have occurred as the exciting fields of BCI and FES have evolved and now overlapped to allow new breakthroughs in medicine, targeting restoration of movement and lost function in users with disabilities.

Comparison and evaluation of single-use LMA supreme versus the reusable proseal LMA in paralyzed patients undergoing surgery with controlled ventilation.

Background and Aims:The objective of this prospective randomized blinded study was to assess the safety and efficacy of the laryngeal mask airway (LMA) Supreme as compared with the LMA Proseal.Material and Methods:A total of 60 patients were randomised into two groups to either receive a Proseal LMA (PLMA) or Supreme LMA (SLMA) for airway management. The primary outcome was to measure oropharyngeal leak pressure (OLP) in both groups. The secondary outcomes were the measurement of insertion time, insertion success rate, fibreoptic grading, intracuff pressure, ease of ventilation, and airway pressure on standard ventilatory settings and postoperative complications.Results:Intracuff pressure increase after 60 minutes of induction was significantly higher in the PLMA group (PLMA 97.43 ± 11.03 cm of H2O and SLMA 75.17 ± 8.95 cm of H2O). OLP was recorded after device insertion, after 30 min and after 60 min in each group and was found to be 28.71 ± 2.97, 30.93 ± 2.87, and 31.93 ± 2.72 cm of H2O in PLMA and 24.84 ± 2.08, 26.73 ± 2.26, and 27.95 ± 2.55 cm of H2O in SLMA group, respectively. The mean OLP with the SLMA was significantly (p=<.001) lower than PLMA. All the other parameters were comparable in both groups.Conclusion:PLMA is better than SLMA as airway device to ventilate at higher airway pressure in paralyzed adult patients. On the basis of our study, we recommend Proseal over Supreme LMA.

Multimodal Interface of Teleoperated Robotic Agent for Patient with Disabilities

This paper presents a teleoperated mobile robot system for supporting paralyzed patients. Teleoperated robotic agent can be one of solutions to prevent a decrease of their QOL caused by social isolation. Most of teleoperation systems have interfaces to visually present the state of the robots including feedback information and receive the control commands manually sent from the operator. However, in elderly and patients with disabilities, they might have difficulty in the manual control of the robot. This paper therefore proposes a multimodal interface combining an eye tracking and shifting of body weight for controlling a teleoperated robotic agent. Furthermore, we conducted a preliminary experiment and questionnaire to discuss the effectiveness of the developed interfaces and compare with each other. From the results, we found that the prototype system still had some problems of controlling the mobile robot caused by disturbances in the gaze input display.

Emotiv EPOC+ fed electrical muscle stimulation system; an inexpensive brain-computer interface for rehabilitation of neuro muscular disorders.

Advancements in the Neuro-rehabilitation across Pakistan is warranted to effectively and efficiently deal with the disease burden of neurological conditions. Being a developing country, an in-expensive treatment approach is required to culminate the rise in the disease occurrence in Pakistan. Brain-Computer Interfaces (BCIs) have come up as a new channel for communication and control, eliminating the need of physical input, opening doors to a wide array of applications in terms of assistive and rehabilitative devices for paralyzed patients and those with neuromuscular disorders. Even with a promising prospect, BCIs and electroencephalograms (EEG) can be very expensive and therefore, they are not practically applicable. For this reason, the purpose of the current study was to come up with a possibility of an inexpensive BCI for rehabilitation of patients with neuro-muscular disorders in Pakistan by using a low-cost and readily available equipment like Emotiv EPOC+ EEG headset and electrical muscle stimulator.

Offline study for implementing human computer interface for elderly paralysed patients using electrooculography and neural networks

Earlier day's people with disability face lot of difficulty in communication due to neuromuscular attack. They are unable to share ideas and thoughts with others so they need some assist to overcome this condition. To overcome the condition, in this paper, we discussed the capabilities of designing electrooculogram (EOG)-based human computer interface (HCI) by ten subjects using power spectral density techniques and neural network. In this study, we compare the right hander performance with left hander performance. Outcomes of the study concluded that lefthander performance was marginally appreciated compared to right hander performance in terms of classification accuracy with an average accuracy of 93.38% for all left hand subjects and 91.38% for all the right subjects using probabilistic neural network (PNN) and also we analysed that during the training left handers were interestingly participated and also they can able to perform the following eleven tasks easily compared with right handers.

A comparison of two supraglottic airway devices in general anaesthesia: baska mask® vs. I-gel®

Objective: The aim of this was to compare the Baska® mask and the I-gel® airway in paralyzed patients during general anaesthesia in terms of clinical performance, the risk of aspiration, and intraoperative and postoperative characteristics.&#x0D; Material and Methods: The two devices were compared in 100 paralyzed anesthetized adult patients. Primary outcomes of the study were to evaluate the characteristics of the airway devices within respect to the success of first insertion attempt, the insertion time, the ease of insertion, leak volume, and peak airway pressure. The blood staining on the mask, and the presence of gastric reflux or sore throat two hours postoperatively were evaluated. Hemodynamics, end-tidal CO2 and the peripheral oxygen saturation measurements were secondary outcomes.&#x0D; Results: No statistically significant difference was observed between the groups in the criteria of first attempt success rate, ease of insertion, blood staining upon removal of the masks, gastric regurgitation, or sore throat two hours after the procedure. The insertion time was significantly longer for the Baska® mask compared with the I-gel® airway. The leak volume was significantly higher in the Baska® mask patients throughout the surgical procedure. The heart rate and mean arterial pressure measurements were significantly higher in the Baska® mask patients.&#x0D; Conclusions: Both the Baska® mask and the I-gel ® device can be used effectively for selected paralyzed patients under general anaesthesia. The insertion time was significantly longer for the Baska® mask compared with the I-gel® device.

From thought to action: The brain–machine interface in posterior parietal cortex

A dramatic example of translational monkey research is the development of neural prosthetics for assisting paralyzed patients. A neuroprosthesis consists of implanted electrodes that can record the intended movement of a paralyzed part of the body, a computer algorithm that decodes the intended movement, and an assistive device such as a robot limb or computer that is controlled by these intended movement signals. This type of neuroprosthetic system is also referred to as a brain–machine interface (BMI) since it interfaces the brain with an external machine. In this review, we will concentrate on BMIs in which microelectrode recording arrays are implanted in the posterior parietal cortex (PPC), a high-level cortical area in both humans and monkeys that represents intentions to move. This review will first discuss the basic science research performed in healthy monkeys that established PPC as a good source of intention signals. Next, it will describe the first PPC implants in human patients with tetraplegia from spinal cord injury. From these patients the goals of movements could be quickly decoded, and the rich number of action variables found in PPC indicates that it is an appropriate BMI site for a very wide range of neuroprosthetic applications. We will discuss research on learning to use BMIs in monkeys and humans and the advances that are still needed, requiring both monkey and human research to enable BMIs to be readily available in the clinic.

Alternative Voice Communication Device using Eye Blink Detection for People with Speech Disorders

Speech disorders is an inability to articulate sound due to medical ailments such as brain damage, stroke to paralysis and several other diseases. Research data suggests that about 15 million people in the world have partial or complete impairment of language expression due to brain damage, mostly from stroke. In this work a low-cost speech assistant device is proposed an alternate augmentative communication device for stroke or paralyzed patients. The eye blink sensor is used as the primary sensor for detection of eye blink. Based on the eye blink gestures the common words are displayed in the LCD and these words are also converted as voice output. This prototype will be an alternate communication aid for people with speech disorders.

Effectiveness of the device for electrostimulation with bio-control “trenar-01” in the rehabilitation of patients with motor deficiency after cerebral stroke

The problem of rehabilitation of patients who have suffered a stroke is relevant at present. The great importance in the processes of rehabilitation after astroke have neuroplasticity of the brain. This approach is implemented in a new class of electronic devices TRENAR® for biologically adequate movements control that are developed at The International Research and Training Center for Information Technologies in Ukraine. evaluation of the functional capabilities of the software device TRENAR-01® in the restoration of arbitrary movements of patients with impaired central motor neuronal function due to acute cerebrovascular accidental ischemic or hemorrhagic origin. Clinical-neurological examination and treatment of 30 patients with cerebral stroke were conducted. 15 electrostimulation procedures were performed on the Trenar-01® machine. After the treatment in the group of patients with acute cerebrovascular accident (23 patients), there was no effect on regression of motor deficit in only one case, when the origin of acute cerebrovascular accident was cardioembolic (with the presence of contraindications for systemic thrombolysis), in patients with long-term consequences of transmitted acute cerebrovascular accident (7 patients) there was a positive dynamics in the reduction of motor deficit. Reliably proved (p < .005) the effectiveness of training movements of the damaged limb according to the program, proceeding from arbitrary reductions of symmetrical healthy muscles in paralyzed patients. The electrostimulation with bio-control “Trenar-01” is expedient in the early stages of rehabilitation in the absence of a cognitive disorder in the patient.

42 Clinical Characteristics of Emergency Department Intubations in Patients With Angioedema: A Report from the National Emergency Airway Registry

Angioedema is common and life-threatening airway obstruction may occur. When intubation is required, it is often difficult to complete when swelling is extensive. First-attempt success is crucial since multiple intubation attempts are associated with increased peri-intubation complications. With more widespread availability of flexible and rigid video equipment, it is important to characterize current airway management practices, success rates and rescue techniques in these patients. We analyzed data from the National Emergency Airway Registry (NEAR), a multicenter prospective observational registry of 25 community and academic EDs. Patients with an intubation attempt for angioedema between January 1, 2016 and December 31, 2017 were included. We report univariate descriptive data as proportions with 95% confidence intervals (CIs). Of 12,044 discrete patient encounters, 71 (0.6%) patients underwent an intubation attempt for angioedema. The median patient age was 59 years (IQR 42 to 64 years), and 17 (23.9%) were female. Emergency physicians were the primary operators during the first-attempt in 92% of cases. Flexible endoscopic devices were the most common initial device (51%) followed by the C-MAC video laryngoscope (21%) and Glidescope video laryngoscope (13%). A direct laryngoscope was used in only 6 cases (8%). Oral and nasal intubation routes were used in 56% and 44%, respectively. A sedative agent was used during first intubation attempt in 82% of encounters and a paralytic was used in 61% of patients. Etomidate and succinylcholine were the most common sedative and paralytic agents administered, respectively. The first-attempt success rate among all angioedema patients was 82% (95% CI [71% to 90%]). Ultimate success was 99%. Nasal routes had a higher first-attempt success rate compared to oral routes (97%, 95% CI [83.3-99.2] vs. 69%, 95% CI [52.4-83.0], respectively). Flexible endoscopes were successful on first-attempt in 33/36 (92%, 95% CI [78%-98%]) patients. Rigid video laryngoscopes and direct laryngoscopes were successful in 24/29 (83%, 95% CI [64%-94%]) and 2/6 (33%, 95% CI [4%-78%]), respectively. The first-attempt success rate among patients in whom a sedative agent was used was 79% (95% CI, [67%-89%]) vs 92% (95% CI, [64%-99%]) among patients in whom no sedative agent was administered. First-attempt success rates were similar between paralyzed and non-paralyzed patients (81% vs. 82%, respectively). No patients underwent a primary cricothyrotomy on first attempt; one patient required a rescue surgical airway. Intubation for angioedema in this multicenter ED cohort was rare. In the hands of emergency physicians, first-attempt success rate was 82% with an ultimate success rate of 99%. The highest first attempt success was observed in patients undergoing nasal flexible endoscopic intubations. Rescue cricothyrotomy was performed once. Further study is needed to determine optimal emergent airway management in this population of patients.

Brain-machine interfaces from motor to mood.

Brain-machine interfaces (BMIs) create closed-loop control systems that interact with the brain by recording and modulating neural activity and aim to restore lost function, most commonly motor function in paralyzed patients. Moreover, by precisely manipulating the elements within the control loop, motor BMIs have emerged as new scientific tools for investigating the neural mechanisms underlying control and learning. Beyond motor BMIs, recent work highlights the opportunity to develop closed-loop mood BMIs for restoring lost emotional function in neuropsychiatric disorders and for probing the neural mechanisms of emotion regulation. Here we review significant advances toward functional restoration and scientific discovery in motor BMIs that have been guided by a closed-loop control view. By focusing on this unifying view of BMIs and reviewing recent work, we then provide a perspective on how BMIs could extend to the neuropsychiatric domain.

Intuitive Gait Pattern Generation for an Exoskeleton Robot

Exoskeleton robots are being studied and developed in various forms according to user. Among them, the most concentrated area is the lower limb exoskeleton robot for “walking,” which is the basic exercise of paralyzed patients. In this study, we utilize the gait cycle, speed, and stride, which are important dependent factors of gait, and not the control technique that uses the predefined gait pattern using the average value of the gait data of the general person used by the existing rehabilitation exoskeleton robot. By creating an end-point reference using a walking element and inverse kinematics, and by using a dynamic movement primitive technique to learn the gait data of the general public, generating the gait patterns of various walking environments without storing them in advance is possible. In this paper, we applied this method to the exoskeleton robot and show robot to generate various strides gait pattern by experiments.