| 1. |
- Dujović, Suzana Dedijer, et al.
(författare)
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Novel multi-pad functional electrical stimulation in stroke patients : A single-blind randomized study
- 2017
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Ingår i: NeuroRehabilitation. - 1053-8135. ; 41:4, s. 791-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Foot drop is common gait impairment after stroke. Functional electrical stimulation (FES) of the ankle dorsiflexor muscles during the swing phase of gait can help correcting foot drop. OBJECTIVE: To evaluate efficacy of additional novel FES system to conventional therapy in facilitating motor recovery in the lower extremities and improving walking ability after stroke. METHODS: Sixteen stroke patients were randomly allocated to the FES group (FES therapy plus conventional rehabilitation program) (n=8), and control group (conventional rehabilitation program) n=8. FES was delivered for 30min during gait to induce ankle plantar and dorsiflexion. Main outcome measures: Gait speed using 10 Meter Walk Test (10 MWT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS) and modified Barthel Index (MBI). RESULTS: Results showed a significant increase in gait speed in FES group (p<0.001), higher than the minimal detected change. The FES group showed improvement in functional independence in the activities of daily living, motor recovery and gait performance. CONCLUSIONS: The findings suggest that novel FES therapy combined with conventional rehabilitation is more effective on walking speed, mobility of the lower extremity, balance disability and activities of daily living compared to a conventional rehabilitation program only.
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| 2. |
- Malešević, Jovana, et al.
(författare)
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A decision support system for electrode shaping in multi-pad FES foot drop correction
- 2017
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Ingår i: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a custom-designed multi-pad electrode, an electrical stimulator, and an inertial measurement unit. Methods: The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. Results: The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. Conclusions: The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop. Trial registration: This study was registered at the Current Controlled Trials website with ClinicalTrials.gov ID NCT02729636 on March 29, 2016.
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| 3. |
- Malešević, Jovana, et al.
(författare)
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Smart protocols for physical therapy of foot drop based on functional electrical stimulation : A case study
- 2021
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Ingår i: Healthcare. - : MDPI AG. - 2227-9032. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Functional electrical stimulation (FES) is used for treating foot drop by delivering electrical pulses to the anterior tibialis muscle during the swing phase of gait. This treatment requires that a patient can walk, which is mostly possible in the later phases of rehabilitation. In the early phase of recovery, the therapy conventionally consists of stretching exercises, and less commonly of FES delivered cyclically. Nevertheless, both approaches minimize patient engagement, which is inconsistent with recent findings that the full rehabilitation potential could be achieved by an active psycho-physical engagement of the patient during physical therapy. Following this notion, we proposed smart protocols whereby the patient sits and ankle movements are FES-induced by self-control. In six smart protocols, movements of the paretic ankle were governed by the non-paretic ankle with different control strategies, while in the seventh voluntary movements of the paretic ankle were used for stimulation triggering. One stroke survivor in the acute phase of recovery participated in the study. During the therapy, the patient’s voluntary ankle range of motion increased and reached the value of normal gait after 15 sessions. Statistical analysis did not reveal the differences between the protocols in FES-induced movements.
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| 4. |
- Alriksson-Schmidt, Ann, et al.
(författare)
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Improving the Health of Individuals With Cerebral Palsy: Protocol for the Multidisciplinary Research Program MOVING ON WITH CP
- 2019
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Ingår i: Jmir Research Protocols. - Toronto, Canada : JMIR Publications Inc.. - 1929-0748. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cerebral palsy (CP) is one of the most common early onset disabilities globally. The causative brain damage in CP is nonprogressive, yet secondary conditions develop and worsen over time. Individuals with CP in Sweden and most of the Nordic countries are systematically followed in the national registry and follow-up program entitled the Cerebral Palsy Follow-Up Program (CPUP). CPUP has improved certain aspects of health care for individuals with CP and strengthened collaboration among professionals. However, there are still issues to resolve regarding health care for this specific population. Objective: The overall objectives of the research program MOVING ON WITH CP are to (1) improve the health care processes and delivery models; (2) develop, implement, and evaluate real-life solutions for Swedish health care provision; and (3) evaluate existing health care and social insurance benefit programs and processes in the context of CP. Methods: MOVING ON WITH CP comprises 9 projects within 3 themes. Evaluation of Existing Health Care (Theme A) consists of registry studies where data from CPUP will be merged with national official health databases, complemented by survey and interview data. In Equality in Health Care and Social Insurance (Theme B), mixed methods studies and registry studies will be complemented with focus group interviews to inform the development of new processes to apply for benefits. In New Solutions and Processes in Health Care Provision (Theme C), an eHealth (electronic health) procedure will be developed and tested to facilitate access to specialized health care, and equipment that improves the assessment of movement activity in individuals with CP will be developed. Results: The individual projects are currently being planned and will begin shortly. Feedback from users has been integrated. Ethics board approvals have been obtained. Conclusions: In this 6-year multidisciplinary program, professionals from the fields of medicine, social sciences, health sciences, and engineering, in collaboration with individuals with CP and their families, will evaluate existing health care, create conditions for a more equal health care, and develop new technologies to improve the health care management of people with CP.
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| 5. |
- Crema, Andrea, et al.
(författare)
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A Wearable Multi-Site System for NMES-Based Hand Function Restoration
- 2018
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Ingår i: IEEE Transactions on Neural Systems and Rehabilitation Engineering. - 1534-4320. ; 26:2, s. 428-440
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Tidskriftsartikel (refereegranskat)abstract
- Reaching and grasping impairments significantly affect the quality of life for people who have experienced a stroke or spinal cord injury. The long-term well-being of patients varies greatly according to the restorable residual capabilities. Electrical stimulation could be a promising solution to restore motor functions in these conditions, but its use is not clinically widespread. Here, we introduce the HandNMES, an electrode array (EA) for neuromuscular electrical stimulation (NMES) aimed at grasp training and assistance. The device was designed to deliver electrical stimulation to extrinsic and intrinsic hand muscles. Six independent EAs, positioned on the user forearm and hand, deliver NMES pulses originating from an external stimulator equipped with demultiplexers for interfacing with a large number of electrodes. The garment was designed to be adaptable to user needs and anthropometric characteristics; size, shape, and contact materials can be customized, and stimulation characteristics such as intensity of stimulation and virtual electrode location, and size can be adjusted. We performed extensive tests with nine healthy subjects showing the efficacy of the HandNMES in terms of stimulation performance and personalization. Because encouraging results were achieved, in the coming months, the HandNMES device will be tested in pilot clinical trials.
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| 6. |
- Crema, Andrea, et al.
(författare)
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Helping Hand grasp rehabilitation : Preliminary assessment on chronic stroke patients
- 2017
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Ingår i: 8th International IEEE EMBS Conference on Neural Engineering, NER 2017. - 9781538619162 ; , s. 146-149
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Konferensbidrag (refereegranskat)abstract
- The Helping Hand (HH) system is a novel grasp rehabilitation platform aimed at simplifying the clinical usage of wearable electrode arrays for neuromuscular electrical stimulation (NMES). In a randomized dose-matched, clinical study we evaluate usability and effectiveness of the HH treatment, and of other enriched upper limb rehabilitation treatments, and compare the outcomes. This paper shows the preliminary clinical results of the trial on 5 chronic stroke patients throughout a 9 weeks, 3 hours per week, hand preshaping training.
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| 7. |
- Liu, Jia, et al.
(författare)
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Analysis of modulations of mental fatigue on intra-individual variability from single-trial event related potentials
- 2024
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Ingår i: Journal of Neuroscience Methods. - 0165-0270. ; 406
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intra-individual variability (IIV), a measure of variance within an individual's performance, has been demonstrated as metrics of brain responses for neural functionality. However, how mental fatigue modulates IIV remains unclear. Consequently, the development of robust mental fatigue detection methods at the single-trial level is challenging. New methods: Based on a long-duration flanker task EEG dataset, the modulations of mental fatigue on IIV were explored in terms of response time (RT) and trial-to-trial latency variations of event-related potentials (ERPs). Specifically, latency variations were quantified using residue iteration decomposition (RIDE) to reconstruct latency-corrected ERPs. We compared reconstructed ERPs with raw ERPs by means of temporal principal component analysis (PCA). Furthermore, a single-trial classification pipeline was developed to detect the changes of mental fatigue levels. Results: We found an increased IIV in the RT metric in the fatigue state compared to the alert state. The same sequence of ERPs (N1, P2, N2, P3a, P3b, and slow wave, or SW) was separated from both raw and reconstructed ERPs using PCA, whereas differences between raw and reconstructed ERPs in explained variances for separated ERPs were found owing to IIV. Particularly, a stronger N2 was detected in the fatigue than alert state after RIDE. The single-trial fatigue detection pipeline yielded an acceptable accuracy of 73.3%. Comparison with existing methods: The IIV has been linked to aging and brain disorders, and as an extension, our finding demonstrates IIV as an efficient indicator of mental fatigue. Conclusions: This study reveals significant modulations of mental fatigue on IIV at the behavioral and neural levels and establishes a robust mental fatigue detection pipeline.
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| 8. |
- Liu, Jia, et al.
(författare)
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Analysis of modulations of mental fatigue on intra-individual variability from single-trial event related potentials
- 2024
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Ingår i: JOURNAL OF NEUROSCIENCE METHODS. - 0165-0270 .- 1872-678X. ; 406
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intra-individual variability (IIV), a measure of variance within an individual's performance, has been demonstrated as metrics of brain responses for neural functionality. However, how mental fatigue modulates IIV remains unclear. Consequently, the development of robust mental fatigue detection methods at the single-trial level is challenging. New methods: Based on a long-duration flanker task EEG dataset, the modulations of mental fatigue on IIV were explored in terms of response time (RT) and trial-to-trial latency variations of event-related potentials (ERPs). Specifically, latency variations were quantified using residue iteration decomposition (RIDE) to reconstruct latency-corrected ERPs. We compared reconstructed ERPs with raw ERPs by means of temporal principal component analysis (PCA). Furthermore, a single-trial classification pipeline was developed to detect the changes of mental fatigue levels. Results: We found an increased IIV in the RT metric in the fatigue state compared to the alert state. The same sequence of ERPs (N1, P2, N2, P3a, P3b, and slow wave, or SW) was separated from both raw and reconstructed ERPs using PCA, whereas differences between raw and reconstructed ERPs in explained variances for separated ERPs were found owing to IIV. Particularly, a stronger N2 was detected in the fatigue than alert state after RIDE. The single-trial fatigue detection pipeline yielded an acceptable accuracy of 73.3%. Comparison with existing methods: The IIV has been linked to aging and brain disorders, and as an extension, our finding demonstrates IIV as an efficient indicator of mental fatigue. Conclusions: This study reveals significant modulations of mental fatigue on IIV at the behavioral and neural levels and establishes a robust mental fatigue detection pipeline.
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| 9. |
- Liu, Jia, et al.
(författare)
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Long term sustained attention alters dynamic functional connectivity patterns
- 2023
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Ingår i: 2023 45th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). - 9798350324488 - 9798350324471
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Konferensbidrag (refereegranskat)abstract
- Mental fatigue has attracted much attention from researchers as it plays a key role in performance efficiency and safety situations. Functional connectivity analysis using graph theory is an effective method for revealing changes in cognition resources influenced by mental fatigue. Previous studies have revealed that functional networks are dynamically reorganized. Therefore, it is critical to explore dynamic timescales of networks related to specific cognitive abilities. In this study, we used an open EEG dataset of twenty-one subjects recorded in a 60-minutes sustained attention task. After preprocessing, we constructed connectivity matrices using the weighted phase lag index (wPLI) in the theta band and characterized them with dynamic graph measures, namely characteristic path length (CPL) and clustering coefficient (CC). The results show that the frontal-parietal brain networks in theta band are involved in a sustaining attention task. When averaging from temporal and spatial activations, CPL and CC decreased with time-on-task. Our results indicate that mental fatigue results in deteriorations in sustaining attention, and graph theory analysis can provide support for mental fatigue analysis.Clinical Relevance— Identification of the effects of long term sustained attention on dynamic brain networks may be potential for mechanism study and detection of mental states and attentional deficits caused by mental diseases.
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| 10. |
- Lundsberg, Jonathan, et al.
(författare)
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Compressed spike-triggered averaging in iterative decomposition of surface EMG
- 2023
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Ingår i: Computer Methods and Programs in Biomedicine. - : Elsevier BV. - 0169-2607. ; 228
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objective: Analysis of motor unit activity is important for assessing and treating diseases or injuries affecting natural movement. State-of-the-art decomposition translates high-density surface electromyography (HDsEMG) into motor unit activity. However, current decomposition methods offer far from complete separation of all motor units. Methods: This paper proposes a peel-offapproach to automatic decomposition of HDsEMG into motor unit action potential (MUAP) trains, based on the Fast Independent Component Analysis algorithm (FastICA). The novel steps include utilizing compression by means of Principal Component Analysis and spike-triggered averaging, to estimate surface MUAP distributions with less noise, which are iteratively subtracted from the HDsEMG dataset. Furthermore, motor unit spike trains are estimated by highdimensional density-based clustering of peaks in the FastICA source output. And finally, a new reliability measure is used to discard poor motor unit estimates by comparing the variance of the FastICA source output before and after the peel-offstep. The method was validated using reconstructed synthetic data at three different signal-to-noise levels and was compared to an established deflationary FastICA approach. Results: Both algorithms had very high recall and precision, over 90%, for spikes from matching motor units, referred to as matched performance. However, the peel-offalgorithm correctly identified more motor units for all noise levels. When accounting for unidentified motor units, total recall was up to 33 percentage points higher; and when accounting for duplicate estimates, total precision was up to 24 percentage points higher, compared to the state-of-the-art reference. In addition, a comparison was done using experimental data where the proposed algorithm had a matched recall of 97% and precision of 85% with respect to the reference algorithm. Conclusion: These results show a substantial performance increase for decomposition of simulated HDsEMG data and serve to validate the proposed approach. This performance increase is an important step towards complete decomposition and extraction of information of motor unit activity. (C) 2022TheAuthor(s). PublishedbyElsevierB.V.
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