Dawn M. Nilsen

Jingxi Xu, Ava Chen, Lauren Winterbottom et al.

Intent inferral, the process by which a robotic device predicts a user's intent from biosignals, offers an effective and intuitive way to control wearable robots. Classical intent inferral methods treat biosignal inputs as unidirectional ground truths for training machine learning models, where the internal state of the model is not directly observable by the user. In this work, we propose reciprocal learning, a bidirectional paradigm that facilitates human adaptation to an intent inferral classifier. Our paradigm consists of iterative, interwoven stages that alternate between updating machine learning models and guiding human adaptation with the use of augmented visual feedback. We demonstrate this paradigm in the context of controlling a robotic hand orthosis for stroke, where the device predicts open, close, and relax intents from electromyographic (EMG) signals and provides appropriate assistance. We use LED progress-bar displays to communicate to the user the predicted probabilities for open and close intents by the classifier. Our experiments with stroke subjects show reciprocal learning improving performance in a subset of subjects (two out of five) without negatively impacting performance on the others. We hypothesize that, during reciprocal learning, subjects can learn to reproduce more distinguishable muscle activation patterns and generate more separable biosignals.

Jingxi Xu, Runsheng Wang, Siqi Shang et al.

Intent inferral on a hand orthosis for stroke patients is challenging due to the difficulty of data collection. Additionally, EMG signals exhibit significant variations across different conditions, sessions, and subjects, making it hard for classifiers to generalize. Traditional approaches require a large labeled dataset from the new condition, session, or subject to train intent classifiers; however, this data collection process is burdensome and time-consuming. In this paper, we propose ChatEMG, an autoregressive generative model that can generate synthetic EMG signals conditioned on prompts (i.e., a given sequence of EMG signals). ChatEMG enables us to collect only a small dataset from the new condition, session, or subject and expand it with synthetic samples conditioned on prompts from this new context. ChatEMG leverages a vast repository of previous data via generative training while still remaining context-specific via prompting. Our experiments show that these synthetic samples are classifier-agnostic and can improve intent inferral accuracy for different types of classifiers. We demonstrate that our complete approach can be integrated into a single patient session, including the use of the classifier for functional orthosis-assisted tasks. To the best of our knowledge, this is the first time an intent classifier trained partially on synthetic data has been deployed for functional control of an orthosis by a stroke survivor. Videos, source code, and additional information can be found at https://jxu.ai/chatemg.

Avinash Parnandi, Aakash Kaku, Anita Venkatesan et al.

Stroke rehabilitation seeks to increase neuroplasticity through the repeated practice of functional motions, but may have minimal impact on recovery because of insufficient repetitions. The optimal training content and quantity are currently unknown because no practical tools exist to measure them. Here, we present PrimSeq, a pipeline to classify and count functional motions trained in stroke rehabilitation. Our approach integrates wearable sensors to capture upper-body motion, a deep learning model to predict motion sequences, and an algorithm to tally motions. The trained model accurately decomposes rehabilitation activities into component functional motions, outperforming competitive machine learning methods. PrimSeq furthermore quantifies these motions at a fraction of the time and labor costs of human experts. We demonstrate the capabilities of PrimSeq in previously unseen stroke patients with a range of upper extremity motor impairment. We expect that these advances will support the rigorous measurement required for quantitative dosing trials in stroke rehabilitation.

Ava Chen, Lauren Winterbottom, Katherine O'Reilly et al.

We present the development of a cable-based passive forearm exoskeleton that is designed to assist supination for hemiparetic stroke survivors. Our device uniquely provides torque sufficient for counteracting spasticity within a below-elbow apparatus. The mechanism consists of a spiral single-tendon routing embedded in a rigid forearm brace and terminated at the hand and upper-forearm. A spool with an internal releasable-ratchet mechanism allows the user to manually retract the tendon and rotate the hand to counteract involuntary pronation synergies due to stroke. We characterize the mechanism with benchtop testing and five healthy subjects, and perform a preliminary assessment of the exoskeleton with a single chronic stroke subject having minimal supination ability. The mechanism can be integrated into an existing active hand-opening orthosis to enable supination support during grasping tasks, and also allows for a future actuated supination strategy.

Ava Chen, Lauren Winterbottom, Sangwoo Park et al.

We propose a dual-cable method of stabilizing the thumb in the context of a hand orthosis designed for individuals with upper extremity hemiparesis after stroke. This cable network adds opposition/reposition capabilities to the thumb, and increases the likelihood of forming a hand pose that can successfully manipulate objects. In addition to a passive-thumb version (where both cables are of fixed length), our approach also allows for a single-actuator active-thumb version (where the extension cable is actuated while the abductor remains passive), which allows a range of motion intended to facilitate creating and maintaining grasps. We performed experiments with five chronic stroke survivors consisting of unimanual resistive-pull tasks and bimanual twisting tasks with simulated real-world objects; these explored the effects of thumb assistance on grasp stability and functional range of motion. Our results show that both active- and passive-thumb versions achieved similar performance in terms of improving grasp force generation over a no-device baseline, but active thumb stabilization enabled users to maintain grasps for longer durations.

Jingxi Xu, Cassie Meeker, Ava Chen et al.

In order to provide therapy in a functional context, controls for wearable robotic orthoses need to be robust and intuitive. We have previously introduced an intuitive, user-driven, EMG-based method to operate a robotic hand orthosis, but the process of training a control that is robust to concept drift (changes in the input signal) places a substantial burden on the user. In this paper, we explore semi-supervised learning as a paradigm for controlling a powered hand orthosis for stroke subjects. To the best of our knowledge, this is the first use of semi-supervised learning for an orthotic application. Specifically, we propose a disagreement-based semi-supervision algorithm for handling intrasession concept drift based on multimodal ipsilateral sensing. We evaluate the performance of our algorithm on data collected from five stroke subjects. Our results show that the proposed algorithm helps the device adapt to intrasession drift using unlabeled data and reduces the training burden placed on the user. We also validate the feasibility of our proposed algorithm with a functional task; in these experiments, two subjects successfully completed multiple instances of a pick-and-handover task.

Avinash Parnandi, Jasim Uddin, Dawn M. Nilsen et al.

Rehabilitation training is the primary intervention to improve motor recovery after stroke, but a tool to measure functional training does not currently exist. To bridge this gap, we previously developed an approach to classify functional movement primitives using wearable sensors and a machine learning (ML) algorithm. We found that this approach had encouraging classification performance but had computational and practical limitations, such as training time, sensor cost, and magnetic drift. Here, we sought to refine this approach and determine the algorithm, sensor configurations, and data requirements needed to maximize computational and practical performance. Motion data had been previously collected from 6 stroke patients wearing 11 inertial measurement units (IMUs) as they moved objects on a target array. To identify optimal ML performance, we evaluated 4 algorithms that are commonly used in activity recognition (linear discriminant analysis (LDA), naïve Bayes, support vector machine, and k-nearest neighbors). We compared their classification accuracy, computational complexity, and tuning requirements. To identify optimal sensor configuration, we progressively sampled fewer sensors and compared classification accuracy. To identify optimal data requirements, we compared accuracy using data from IMUs versus accelerometers. We found that LDA had the highest classification accuracy (92%) of the algorithms tested. It also was the most pragmatic, with low training and testing times and modest tuning requirements. We found that 7 sensors on the paretic arm and back resulted in the best accuracy. Using this array, accelerometers had a lower accuracy (84%). We refined strategies to accurately and pragmatically quantify functional movement primitives in stroke patients. We propose that this optimized ML-sensor approach could be a means to quantify training dose after stroke.