Knowledge Vault 3/71 - G.TEC BCI & Neurotechnology Spring School 2024 - Day 8
Lower limb stroke rehabilitation with recoveriX
Woosang Cho, g.tec medical engineering GmbH (AT
<Resume Image >

Concept Graph & Resume using Claude 3 Opus | Chat GPT4 | Llama 3:

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background, procedures, assessments, results. 1] A --> C[BCI efficacy in stroke
motor rehab proven. 2] C --> D[Recoveries successful for
upper limb paralysis. 2] A --> E[Lower limb and gait
rehab essential for life. 3] E --> F[Foot drop: common issue,
limits safe walking. 3] F --> G[Normal walking: dorsiflexion, plantar
flexion, inversion. Tibialis anterior key. 4] F --> H[Foot drop patients swing
leg out, limiting speed, safety. 5] E --> I[Recoveries: better ankle control,
speed, safety. 6] A --> J[Rehab keys: intensity,
repetition, early initiation. 7] J --> K[Recoveries leverages rehab principles. 7] A --> L[BCI detects intention, provides
FES feedback, improves plasticity. 8] L --> M[Closed-loop feedback enables recovery,
muscle function. FES, neurofeedback, mental practice. 9] A --> N[Training: 16-ch EEG, FES
electrodes on muscles. 10] N --> O[Patients imagine left/right movements,
FES moves foot. 11] O --> P[Tibialis anterior electrode placement
crucial. Intensity adjusted. 12] N --> Q[8s trials: cue, imagine,
rest. Right cue = right foot. 13] N --> R[ERD features: reduced mu/beta
in contralateral hemisphere. 14] N --> S[Classifier updated each run
for online neurofeedback. 15] N --> T[GUI: cues, real-time feedback.
Therapists monitor. 16] A --> U[25 sessions over 2.5
months, 240 trials each. 17] A --> V[Pre/post measures: ROM, TUG,
10MWT, video analysis. 18] V --> W[2022 study: significant speed
improvements post-recoveries. 19] V --> X[Videos show gait, balance,
assistive device improvements. 20] N --> Y[2 FES electrodes pass
muscle current. 1.5s ERD delay. 21] A --> Z[Recoveries: medical device, needs
supervision. Supplements standard therapy. 22] A --> AA[Meta-analyses: FES-BCI may beat
conventional therapy alone. 23] AA --> AB[Recoveries helps even severely impaired. 23] A --> AC[FES-BCI training promotes neuroplasticity,
motor learning, regained function. 24] A --> AD[SCI patients also improved
with recoveries, enabling advanced gait. 25] A --> AE[Standardized recoveries protocol customizable.
Intensive, repetitive, BCI-guided FES key. 26] A --> AF[Recoveries harnesses neuroplasticity via
repetitive goal-oriented movement, sensory feedback. 27] A --> AG[Foot drop: recoveries restores
ankle control, strength, ROM. 28] A --> AH[Recoveries gait training: faster,
safer post-stroke/SCI walking. 29] A --> AI[Recoveries: powerful BCI-FES tool
leveraging neuroplasticity, motor learning. 30] class A,B,C,D stroke; class E,F,G,H,I,AG,AH footdrop; class J,K,L,M,AC,AF,AI rehabilitation; class N,O,P,Q,R,S,T,U,Y,Z,AE training; class V,W,X,AA,AB,AD results; class recoveries fill:#d4f9d4,stroke:#f9d4d4,stroke;


1.- Wosang Cho discusses lower limb stroke rehabilitation using recoveries, a BCI system, covering background, procedures, assessments, and results.

2.- Efficacy of BCI in stroke motor rehabilitation has been demonstrated in multiple meta-analyses. Recoveries previously showed success for upper limb paralysis.

3.- Lower limb and gait rehabilitation is essential for daily life. Foot drop is a common issue that makes safe walking difficult.

4.- During normal walking, dorsiflexion, plantar flexion, and inversion occur. Tibialis anterior muscle plays a key role. Foot drop prevents this.

5.- Stroke patients with foot drop have to swing their leg outward while walking to avoid catching their toe, limiting speed and safety.

6.- Recoveries aims to enable stroke patients to better control ankle movement during gait, improving walking speed and reducing injury risk.

7.- Key factors in rehabilitation include intensity, repetition, and early initiation of therapy. Recoveries leverages these principles.

8.- The BCI system detects patient's intention to move, provides feedback to move foot via FES, and the sensory feedback improves cortical plasticity.

9.- The closed-loop sensorimotor feedback enables motor recovery and improved muscle function. Combining FES, neurofeedback, and mental practice amplifies the effect.

10.- During training, a 16-channel wireless EEG records from sensorimotor areas. FES electrodes stimulate target muscles based on classifier output.

11.- Patients imagine left/right movements based on cues. EEG detects motor imagery and triggers FES to move the corresponding foot.

12.- Electrode placement over tibialis anterior is crucial. Stimulation intensity is adjusted to get foot movement with minimal discomfort and fatigue.

13.- Each trial lasts 8s - auditory cue at 0s, imagine movement for 6s, 1.5s rest. Right cue = imagine moving right foot.

14.- EEG features used are event-related desynchronization (ERD) - reduced mu/beta power during movement or motor imagery, occurring in contralateral hemisphere.

15.- After each training run, the classifier is updated using the patient's own EEG data to provide adaptive online neurofeedback.

16.- The recoveries GUI displays cues, provides real-time feedback on classification and FES triggering. Therapists monitor signal quality and patient engagement.

17.- A typical treatment includes 25 sessions, 2-3 per week over 2.5 months. Each session has 240 trials (120 FES activations).

18.- To assess improvements, various pre/post measures are used: range of motion, timed up & go, 10m walk test, video analysis.

19.- A 2022 study showed significant improvements in walking speed (timed up & go and 10m walk tests) after recoveries foot therapy.

20.- Video examples demonstrate substantial functional improvements in gait, balance and assistive device use after 25 sessions of recoveries training.

21.- Two FES electrodes are used to pass current through the muscle. A 1.5s delay accounts for the latency of ERD after cue.

22.- Recoveries is a medical device requiring supervised use after formal training, not open-source. It can supplement but not replace standard therapy.

23.- Meta-analyses suggest FES-BCI may provide larger benefits than conventional therapy alone. Recoveries foot therapy can help even severely impaired patients.

24.- Repetitive, goal-oriented FES-BCI training promotes neuroplasticity and motor learning, allowing patients to regain foot/ankle control and function.

25.- Spinal cord injury patients have also shown marked improvements with recoveries, serving as a bridge to more advanced gait therapies.

26.- The standardized recoveries protocol was developed over 7 years but can be customized. The key is intensive, repetitive, BCI-guided FES.

27.- Recoveries harnesses neuroplasticity by providing high repetitions of goal-oriented movement with sensory feedback, promoting motor learning even in chronic stroke.

28.- For foot drop, recoveries enables restored voluntary ankle control via cortical plasticity, as well as renewed strength and range of motion.

29.- By improving ankle control, recoveries gait training leads to faster, safer, more functional walking post-stroke or incomplete spinal cord injury.

30.- Recoveries is a powerful tool to restore lower limb function via BCI-FES, leveraging neuroplasticity and motor learning principles in neurorehabilitation.

Knowledge Vault built byDavid Vivancos 2024