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A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

Indian Institute of Technology Gandhinagar

Mastoidectomy is a core surgical procedure in otologic surgery. It is believed that the procedure is performed by different surgeons with some variability. However, it is also believed that all surgeons use a finite number of fundamental surgical actions to complete the procedure. To determine how a surgeon performs a mastoidectomy, we sought to identify the fundamental surgical actions [called action primitives (APs)] and determine the transition boundaries among those APs. Our motivation for this paper is both to delineate the APs necessary to complete a mastoidectomy and to optimize and potentially automate the surgical process. In this paper, we present a new approach to developing methods for parsing raw data (position and orientation of the surgical tool and end-effector force) into a sequence of surgical tasks. The overall objective is to de-construct the surgical procedure into a series of APs. This paper presents results from our initial investigation on detecting transition boundaries and identifying APs involved in mastoidectomy.

A step toward identification of surgical actions in mastoidectomy.

Impairments in social communication skills are thought to be core deficits in children with autism spectrum disorder (ASD). In recent years, several assistive technologies, particularly Virtual Reality (VR), have been investigated to promote social interactions in this population. It is well known that children with ASD demonstrate atypical viewing patterns during social interactions and thus monitoring eye-gaze can be valuable to design intervention strategies. While several studies have used eye-tracking technology to monitor eye-gaze for offline analysis, there exists no real-time system that can monitor eye-gaze dynamically and provide individualized feedback. Given the promise of VR-based social interaction and the usefulness of monitoring eye-gaze in real-time, a novel VR-based dynamic eye-tracking system is developed in this work. This system, called Virtual Interactive system with Gaze-sensitive Adaptive Response Technology (VIGART), is capable of delivering individualized feedback based on a child's dynamic gaze patterns during VR-based interaction. Results from a usability study with six adolescents with ASD are presented that examines the acceptability and usefulness of VIGART. The results in terms of improvement in behavioral viewing and changes in relevant eye physiological indexes of participants while interacting with VIGART indicate the potential of this novel technology.

Design of a gaze-sensitive virtual social interactive system for children with autism.

Children with autism spectrum disorder (ASD) demonstrate potent impairments in social communication skills including atypical viewing patterns during social interactions. Recently, several assistive technologies, particularly virtual reality (VR), have been investigated to address specific social deficits in this population. Some studies have coupled eye-gaze monitoring mechanisms to design intervention strategies. However, presently available systems are designed to primarily chain learning via aspects of one's performance only which affords restricted range of individualization. The presented work seeks to bridge this gap by developing a novel VR-based interactive system with Gaze-sensitive adaptive response technology that can seamlessly integrate VR-based tasks with eye-tracking techniques to intelligently facilitate engagement in tasks relevant to advancing social communication skills. Specifically, such a system is capable of objectively identifying and quantifying one's engagement level by measuring real-time viewing patterns, subtle changes in eye physiological responses, as well as performance metrics in order to adaptively respond in an individualized manner to foster improved social communication skills among the participants. The developed system was tested through a usability study with eight adolescents with ASD. The results indicate the potential of the system to promote improved social task performance along with socially-appropriate mechanisms during VR-based social conversation tasks.

Design of a virtual reality based adaptive response technology for children with autism.

Emerging technology, especially robotic technology, has been shown to be appealing to children with autism spectrum disorders (ASD). Such interest may be leveraged to provide repeatable, accurate and individualized intervention services to young children with ASD based on quantitative metrics. However, existing robot-mediated systems tend to have limited adaptive capability that may impact individualization. Our current work seeks to bridge this gap by developing an adaptive and individualized robot-mediated technology for children with ASD. The system is composed of a humanoid robot with its vision augmented by a network of cameras for real-time head tracking using a distributed architecture. Based on the cues from the child's head movement, the robot intelligently adapts itself in an individualized manner to generate prompts and reinforcements with potential to promote skills in the ASD core deficit area of early social orienting. The system was validated for feasibility, accuracy, and performance. Results from a pilot usability study involving six children with ASD and a control group of six typically developing (TD) children are presented.

A step towards developing adaptive robot-mediated intervention architecture (ARIA) for children with autism.

Children with Autism Spectrum Disorder are often characterized by deficits in social communication skills. While evidence suggests that intensive individualized interventions can improve aspects of core deficits in Autism Spectrum Disorder, at present numerous potent barriers exist related to accessing and implementing such interventions. Researchers are increasingly employing technology to develop more accessible, quantifiable, and individualized intervention tools to address core vulnerabilities related to autism. The present study describes the development and preliminary application of a Virtual Reality technology aimed at facilitating improvements in social communication skills for adolescents with autism. We present preliminary data from the usability study of this technological application for six adolescents with autism and discuss potential future development and application of adaptive Virtual Reality technology within an intervention framework.

Dynamic Eye gaze and its Potential in Virtual Reality Based Applications for Children with Autism Spectrum Disorders.

Clinical applications of advanced technology may hold promise for addressing impairments associated with autism spectrum disorders (ASD). This project evaluated the application of a novel physiologically responsive virtual reality based technological system for conversation skills in a group of adolescents with ASD. The system altered components of conversation based on (1) performance alone or (2) the composite effect of performance and physiological metrics of predicted engagement (e.g., gaze pattern, pupil dilation, blink rate). Participants showed improved performance and looking pattern within the physiologically sensitive system as compared to the performance based system. This suggests that physiologically informed technologies may have the potential of being an effective tool in the hands of interventionists.

A physiologically informed virtual reality based social communication system for individuals with autism.

Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI) can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES) where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop BMI is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems, and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm toward motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered toward improvement of visuomotor task performance with non-invasive brain stimulation (NIBS). This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related experimental findings.

Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review.

Individuals with Autism are characterized by deficits in socialization and communication. In recent years several assistive technologies, e.g., Virtual Reality (VR), have been investigated to address the socialization deficits in these individuals. Presently available VR-based systems address various aspects of social communication in an isolated manner and without monitoring one's affective state such as, anxiety. However, in conventional observation-based therapy, a therapist adjusts the intervention paradigm by monitoring one's anxiety level. But, often these individuals have an inherent inability to explicitly express their anxiety thereby inducing limitations on conventional techniques. Physiological signals being continuously available and not directly impacted by these communication difficulties can be alternatively used as markers of one's anxiety level. In our research we aim at designing a Virtual-reality bAsed Social-communication Task (VAST) system that can address the various aspects of social communication, e.g., social context, subtle social cues, emotional expression, etc., in a cumulative and structured way. In addition, we augment this with a capability to use one's physiological signals as markers of one's anxiety level. In our preliminary feasibility study we investigate the potential of VAST to cause variations in one's performance and anxiety level that can be mapped from one's physiological indices.

Understanding the Psycho-Physiological Implications of Interaction With a Virtual Reality-Based System in Adolescents With Autism: A Feasibility Study.

Eye movements are a continuous and ubiquitous part of sensory perception. To properly generate highly accurate and co-ordinate ocular movements, a vast network of brain areas are engaged, from low-level visual processing to motor control of gaze orientation. This renders oculomotor system vulnerable to various neurological disorders with unique clinical patterns. Therefore, oculomotor examination can serve as an early and sensitive indicator for various neurological conditions. A simple-to-use, clinically valid system for objectively assessing the oculomotor function can thus bring a paradigm shift in diagnosis and treatment of brain disorders. In principal accordance, this paper presents a gaze assessment tool, called SmartEye, which is based on eye fixation, smooth pursuit, and blinking in response to both static and dynamic visual stimuli. The gaze related indices were evaluated in real-time by SmartEye and these were mapped to the reported pathological state in chronic (>3 months) patients with stroke. Our preliminary feasibility study with 8 pairs of chronic (>3 months) stroke survivors and healthy individuals revealed that gaze related indices in response to both static and dynamic visual stimuli may serve as potential quantitative biomarkers for stroke assessment.

Article	Year
A step toward identification of surgical actions in mastoidectomy. IEEE transactions on bio-medical engineering\| PubMed ID: 19770082	2010
Design of a gaze-sensitive virtual social interactive system for children with autism. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 21609889	2011
Design of a virtual reality based adaptive response technology for children with autism. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 23033333	2013
A step towards developing adaptive robot-mediated intervention architecture (ARIA) for children with autism. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 23221831	2013
Dynamic Eye gaze and its Potential in Virtual Reality Based Applications for Children with Autism Spectrum Disorders. Autism-open access\| PubMed ID: 23504265	2011
A physiologically informed virtual reality based social communication system for individuals with autism. Journal of autism and developmental disorders\| PubMed ID: 25261247	2015
Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review. Frontiers in neuroscience\| PubMed ID: 25565937	2014
Understanding the Psycho-Physiological Implications of Interaction With a Virtual Reality-Based System in Adolescents With Autism: A Feasibility Study. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 25643409	2015
SmartEye: Developing a Novel Eye Tracking System for Quantitative Assessment of Oculomotor Abnormalities. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 26780816	2016

Uttama Lahiri

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