Towards functional robotic training: motor learning of dynamic tasks is enhanced by haptic rendering but hampered by arm weight support.

BACKGROUND: Current robot-aided training allows for high-intensity training but might hamper the transfer of learned skills to real daily tasks. Many of these tasks, e.g., carrying a cup of coffee, require manipulating objects with complex dynamics. Thus, the absence of somatosensory information regarding the interaction with virtual objects during robot-aided training might be limiting the potential benefits of robotic training on motor (re)learning. We hypothesize that providing somatosensory information through the haptic rendering of virtual environments might enhance motor learning and skill transfer. Furthermore, the inclusion of haptic rendering might increase the task realism, enhancing participants' agency and motivation. Providing arm weight support during training might also enhance learning by limiting participants' fatigue. METHODS: We conducted a study with 40 healthy participants to evaluate how haptic rendering and arm weight support affect motor learning and skill transfer of a dynamic task. The task consisted of inverting a virtual pendulum whose dynamics were haptically rendered on an exoskeleton robot designed for upper limb neurorehabilitation. Participants trained with or without haptic rendering and with or without weight support. Participants' task performance, movement strategy, effort, motivation, and agency were evaluated during baseline, short- and long-term retention. We also evaluated if the skills acquired during training transferred to a similar task with a shorter pendulum. RESULTS: We found that haptic rendering significantly increases participants' movement variability during training and the ability to synchronize their movements with the pendulum, which is correlated with better performance. Weight support also enhances participants' movement variability during training and reduces participants' physical effort. Importantly, we found that training with haptic rendering enhances motor learning and skill transfer, while training with weight support hampers learning compared to training without weight support. We did not observe any significant differences between training modalities regarding agency and motivation during training and retention tests. CONCLUSION: Haptic rendering is a promising tool to boost robot-aided motor learning and skill transfer to tasks with similar dynamics. However, further work is needed to find how to simultaneously provide robotic assistance and haptic rendering without hampering motor learning, especially in brain-injured patients. Trial registration https://clinicaltrials.gov/show/NCT04759976.

Congruency of Information Rather Than Body Ownership Enhances Motor Performance in Highly Embodied Virtual Reality.

In immersive virtual reality, the own body is often visually represented by an avatar. This may induce a feeling of body ownership over the virtual limbs. Importantly, body ownership and the motor system share neural correlates. Yet, evidence on the functionality of this neuroanatomical coupling is still inconclusive. Findings from previous studies may be confounded by the congruent vs. incongruent multisensory stimulation used to modulate body ownership. This study aimed to investigate the effect of body ownership and congruency of information on motor performance in immersive virtual reality. We aimed to modulate body ownership by providing congruent vs. incongruent visuo-tactile stimulation (i.e., participants felt a brush stroking their real fingers while seeing a virtual brush stroking the same vs. different virtual fingers). To control for congruency effects, unimodal stimulation conditions (i.e., only visual or tactile) with hypothesized low body ownership were included. Fifty healthy participants performed a decision-making (pressing a button as fast as possible) and a motor task (following a defined path). Body ownership was assessed subjectively with established questionnaires and objectively with galvanic skin response (GSR) when exposed to a virtual threat. Our results suggest that congruency of information may decrease reaction times and completion time of motor tasks in immersive virtual reality. Moreover, subjective body ownership is associated with faster reaction times, whereas its benefit on motor task performance needs further investigation. Therefore, it might be beneficial to provide congruent information in immersive virtual environments, especially during the training of motor tasks, e.g., in neurorehabilitation interventions.

"Tricking the Brain" Using Immersive Virtual Reality: Modifying the Self-Perception Over Embodied Avatar Influences Motor Cortical Excitability and Action Initiation.

To offer engaging neurorehabilitation training to neurologic patients, motor tasks are often visualized in virtual reality (VR). Recently introduced head-mounted displays (HMDs) allow to realistically mimic the body of the user from a first-person perspective (i.e., avatar) in a highly immersive VR environment. In this immersive environment, users may embody avatars with different body characteristics. Importantly, body characteristics impact how people perform actions. Therefore, alternating body perceptions using immersive VR may be a powerful tool to promote motor activity in neurologic patients. However, the ability of the brain to adapt motor commands based on a perceived modified reality has not yet been fully explored. To fill this gap, we "tricked the brain" using immersive VR and investigated if multisensory feedback modulating the physical properties of an embodied avatar influences motor brain networks and control. Ten healthy participants were immersed in a virtual environment using an HMD, where they saw an avatar from first-person perspective. We slowly transformed the surface of the avatar (i.e., the "skin material") from human to stone. We enforced this visual change by repetitively touching the real arm of the participant and the arm of the avatar with a (virtual) hammer, while progressively replacing the sound of the hammer against skin with stone hitting sound via loudspeaker. We applied single-pulse transcranial magnetic simulation (TMS) to evaluate changes in motor cortical excitability associated with the illusion. Further, to investigate if the "stone illusion" affected motor control, participants performed a reaching task with the human and stone avatar. Questionnaires assessed the subjectively reported strength of embodiment and illusion. Our results show that participants experienced the "stone arm illusion." Particularly, they rated their arm as heavier, colder, stiffer, and more insensitive when immersed with the stone than human avatar, without the illusion affecting their experienced feeling of body ownership. Further, the reported illusion strength was associated with enhanced motor cortical excitability and faster movement initiations, indicating that participants may have physically mirrored and compensated for the embodied body characteristics of the stone avatar. Together, immersive VR has the potential to influence motor brain networks by subtly modifying the perception of reality, opening new perspectives for the motor recovery of patients.

Human arm weight compensation in rehabilitation robotics: efficacy of three distinct methods.

BACKGROUND: Arm weight compensation with rehabilitation robots for stroke patients has been successfully used to increase the active range of motion and reduce the effects of pathological muscle synergies. However, the differences in structure, performance, and control algorithms among the existing robotic platforms make it hard to effectively assess and compare human arm weight relief. In this paper, we introduce criteria for ideal arm weight compensation, and furthermore, we propose and analyze three distinct arm weight compensation methods (Average, Full, Equilibrium) in the arm rehabilitation exoskeleton 'ARMin'. The effect of the best performing method was validated in chronic stroke subjects to increase the active range of motion in three dimensional space. METHODS: All three methods are based on arm models that are generalizable for use in different robotic devices and allow individualized adaptation to the subject by model parameters. The first method Average uses anthropometric tables to determine subject-specific parameters. The parameters for the second method Full are estimated based on force sensor data in predefined resting poses. The third method Equilibrium estimates parameters by optimizing an equilibrium of force/torque equations in a predefined resting pose. The parameters for all three methods were first determined and optimized for temporal and spatial estimation sensitivity. Then, the three methods were compared in a randomized single-center study with respect to the remaining electromyography (EMG) activity of 31 healthy participants who performed five arm poses covering the full range of motion with the exoskeleton robot. The best method was chosen for feasibility tests with three stroke patients. In detail, the influence of arm weight compensation on the three dimensional workspace was assessed by measuring of the horizontal workspace at three different height levels in stroke patients. RESULTS: All three arm weight compensation methods reduced the mean EMG activity of healthy subjects to at least 49% compared with the no compensation reference. The Equilibrium method outperformed the Average and the Full methods with a highly significant reduction in mean EMG activity by 19% and 28% respectively. However, upon direct comparison, each method has its own individual advantages such as in set-up time, cost, or required technology. The horizontal workspace assessment in poststroke patients with the Equilibrium method revealed potential workspace size-dependence of arm height, while weight compensation helped maximize the workspace as much as possible. CONCLUSION: Different arm weight compensation methods were developed according to initially defined criteria. The methods were then analyzed with respect to their sensitivity and required technology. In general, weight compensation performance improved with the level of technology, but increased cost and calibration efforts. This study reports a systematic way to analyze the efficacy of different weight compensation methods using EMG. Additionally, the feasibility of the best method, Equilibrium, was shown by testing with three stroke patients. In this test, a height dependence of the workspace size also seemed to be present, which further highlights the importance of patient-specific weight compensation, particularly for training at different arm heights. TRIAL REGISTRATION: ClinicalTrials.gov,NCT02720341. Registered 25 March 2016.

Promoting Motor Variability During Robotic Assistance Enhances Motor Learning of Dynamic Tasks.

Despite recent advances in robot-assisted training, the benefits of haptic guidance on motor (re)learning are still limited. While haptic guidance may increase task performance during training, it may also decrease participants' effort and interfere with the perception of the environment dynamics, hindering somatosensory information crucial for motor learning. Importantly, haptic guidance limits motor variability, a factor considered essential for learning. We propose that Model Predictive Controllers (MPC) might be good alternatives to haptic guidance since they minimize the assisting forces and promote motor variability during training. We conducted a study with 40 healthy participants to investigate the effectiveness of MPCs on learning a dynamic task. The task consisted of swinging a virtual pendulum to hit incoming targets with the pendulum ball. The environment was haptically rendered using a Delta robot. We designed two MPCs: the first MPC-end-effector MPC-applied the optimal assisting forces on the end-effector. A second MPC-ball MPC-applied its forces on the virtual pendulum ball to further reduce the assisting forces. The participants' performance during training and learning at short- and long-term retention tests were compared to a control group who trained without assistance, and a group that trained with conventional haptic guidance. We hypothesized that the end-effector MPC would promote motor variability and minimize the assisting forces during training, and thus, promote learning. Moreover, we hypothesized that the ball MPC would enhance the performance and motivation during training but limit the motor variability and sense of agency (i.e., the feeling of having control over their movements), and therefore, limit learning. We found that the MPCs reduce the assisting forces compared to haptic guidance. Training with the end-effector MPC increases the movement variability and does not hinder the pendulum swing variability during training, ultimately enhancing the learning of the task dynamics compared to the other groups. Finally, we observed that increases in the sense of agency seemed to be associated with learning when training with the end-effector MPC. In conclusion, training with MPCs enhances motor learning of tasks with complex dynamics and are promising strategies to improve robotic training outcomes in neurological patients.

Multi-purpose Robotic Training Strategies for Neurorehabilitation with Model Predictive Controllers.

One of the main challenges in robotic neuroreha-bilitation is to understand how robots should physically interact with trainees to optimize motor leaning. There is evidence that motor exploration (i.e., the active exploration of new motor tasks) is crucial to boost motor learning. Furthermore, effectiveness of a robotic training strategy depends on several factors, such as task type and trainee's skill level. We propose that Model Predictive Controllers (MPC) can satisfy many training/trainee's needs simultaneously, while providing a safe environment without restricting trainees to a fixed trajectory. We designed two nonlinear MPCs to support training of a rich dynamic task (a pendulum task) with a delta robot. These MPCs differ from each other in terms of the application point of the intervention force: (i) to the virtual pendulum mass, and (ii) the virtual rod holding point, which corresponds to the robot end-effector. The effect of the MPCs on task performance, physical effort, motivation and sense of agency was evaluated in fourteen healthy participants. We found that the location of the applied controller force affects the task performance -i.e., the MPC that actuates on the pendulum mass significantly reduced performance errors and sense of agency during training, while the other MPC did not, probably due to low force saturation limits and slow optimization speed of the solver. Participants applied significantly more forces when training with the MPC that actuates on the pendulum holding point, probably because they reacted against the robotic assistance. Although MPCs look very promising for neurorehabilitation, further steps have to be taken to improve their technical limitations. Moreover, the effects of MPCs on motor learning should be evaluated.

Virtual Reality Environments and Haptic Strategies to Enhance Implicit Learning and Motivation in Robot-Assisted Training.

Motivation plays a crucial role in motor learning and neurorehabilitation. Participants' motivation could decline to a point where they may stop training when facing a very difficult task. Conversely, participants may perform well and consider the training boring if the task is too easy. In this paper, we present a combination of a virtual reality environment with different robotic training strategies that modify task functional difficulty to enhance participants' motivation. We employed a pneumatically driven robotic stepper as a haptic interface. We first evaluated the use of disturbance observers as acceleration controllers to provide high robustness to varying system parameters, unmodeled dynamics and unknown disturbances associated with pneumatic control. The locomotor task to be learned in the virtual reality environment consisted of steering a recumbent bike to follow a desired path by changing the movement frequency of the dominant leg. The motor task was specially designed to engage implicit learning -i.e., learning without conscious recognition of what is learned. A haptic assistance strategy was developed in order to reduce the task functional difficulty during practice. In a feasibility study with eight healthy participants, we found that the haptic assistance provided by the robotic device successfully contributed to improve task performance during training, especially for less skilled participants. Furthermore, we found a negative correlation between participants' motivation and performance error when training with haptic assistance, suggesting that haptic assistance has a great potential to enhance motivation during motor training.

Feedforward model based arm weight compensation with the rehabilitation robot ARMin.

Highly impaired stroke patients at early stages of recovery are unable to generate enough muscle force to lift the weight of their own arm. Accordingly, task-related training is strongly limited or even impossible. However, as soon as partial or full arm weight support is provided, patients are enabled to perform arm rehabilitation training again throughout an increased workspace. In the literature, the current solutions for providing arm weight support are mostly mechanical. These systems have components that restrict the freedom of movement or entail additional disturbances. A scalable weight compensation for upper and lower arm that is online adjustable as well as generalizable to any robotic system is necessary. In this paper, a model-based feedforward weight compensation of upper and lower arm fulfilling these requirements is introduced. The proposed method is tested with the upper extremity rehabilitation robot ARMin V, but can be applied in any other actuated exoskeleton system. Experimental results were verified using EMG measurements. These results revealed that the proposed weight compensation reduces the effort of the subjects to 26% on average and more importantly throughout the entire workspace of the robot.