Hybrid biosignals-based control method on brain/neural hand

exoskeleton system
Sergio Esteban Quintero Benavides
squintero@unal.edu.co

The Hybrid EEG/EOG-based control method [1] used to control a brain/neural hand ex-
oskeleton (B/NHE) provides independency for patients with quadriplegia during the execu-
tion of activities of daily living (ADLs). The success of this system lay in the combination of
non-invasive electroencephalography (EEG) and electrooculography (EOG) methods to reg-
ulate the open and close motions of the hand exoskeleton. The dexterous ability of patients
was measured using the Toronto Rehabilitation Institute–Hand Function Test (TRI-HFT)[2],
whereas the grade of independence was established with the Spinal Cord Independence Mea-
sure (SCIM) [3] and Functional Independence Measure (FIM) [4].

EEG is a method used to measure the electrical activity on the external surface of the brain
[5], this method can be invasive or non-invasive which indicates if the electrodes are in direct
contact with the brain or not. As brain activity is not a time stable process EEG signals are
nonstationary [6], which are harder to analyze. Added to that, the noninvasive EEG method
is more noise sensitive due to environmental factors. Because of these characteristics, the
exclusive use of this method to control a brain/neural device is unreliable and difficult to
implement.

EOG emerges to partially compensate for those EEG disadvantages. EOG measures the elec-
trical potential difference (standing potential) between the frontal and back part of the eye
[7], the signal is obtained with electrodes placed on both temples that detect the potential
when the eyes perform a horizontal movement. In the end, the EEG signal was used to exe-
cute the hand close motion and the EOG performed the hand open motion. It is important
to mention that after a hand open motion the system does not process any signal for 1.5
seconds to get a better performance in the goal task [1].

The system was proved by six patients who were classified with two different American Spinal
Cord Injury Association (ASIA) criteria that determine the impairment grade of the lower
limbs (A, B, and C) and the cervical injury level (C4 to C6) [1]. In Table 1 it is possible to
see the TRI-HFT mean scores got by patients executing ADLs with and without the B/NHE
system, also it shows the SCIM, and FIM measures got on the baseline test (w.o. B/NHE).

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 TRI-HFT mean score SCIM FIM
w.o. B/NHE system 3.81 ± 1.38 40.0 ± 17.6 39.17 ± 21.62
w. B/NHE system 5.96 ± 0.54 - -

Table 1: TRI-HFT mean score, SCIM, and FIM measures of the performed tests [1]

The TRI-HFT score takes values from 0 to 7 where 0, represents no movement at all and 7,
complete manipulation of the object with an active grasp. The B/NHE system significantly
improves the manipulation capabilities of patients, and it was determined that hand function
achieved 84.96 ± 7.19% of the maximum score [1], which means that patients restore their
independence performing ADLs. Finally, the average intraclass correlation coefficient (ICC)
was 0.96 calculated within a 95% confidence interval [1], in other words, the method used to
calculate the TRI-HFT score was reliable and supported the obtained numerical results.

The technology presented achieves its goal to provide reliable manipulability control to pa-
tients and expose how effective this system can be for the rehabilitation of patients with
spinal cord injuries. However, there are some points that were considered to improve but
were not implemented in the system as force control to grasp objects with different me-
chanical properties and velocity control to adapt the system to different patient conditions.
Additionally, the use of noninvasive methods to get biosignals is very attractive for future
implementations leaving the door open for forwarding improvements in the signal processing
field to use only one biosignal to control the B/NHE.

As it was exposed, the biosignal-based control method proposed shows remarkable results in
controlling the B/NHE system, helping patients with quadriplegia to recover their indepen-
dency executing ADLs. Also, it proposes several ideas to explore future research around the
interaction of active rehabilitation devices with the body through Brain-Machine Interfaces
to improve the life of people with spinal cord injuries.

References
[1] S. R. Soekadar, M. Witkowski, C. Gómez, E. Opisso, J. Medina, M. Cortese, M. Cempini,
M. C. Carrozza, L. G. Cohen, N. Birbaumer, and et al. “Hybrid EEG/EOG-based
Brain/neural hand exoskeleton restores fully independent daily living activities after
quadriplegia”. In: Science Robotics 1 (2016).
[2] N Kapadia, V Zivanovic, M Verrier, and M Popovic. “Toronto Rehabilitation Insti-
tute–Hand Function Test: Assessment of gross motor function in individuals with spinal
cord injury”. In: Topics in Spinal Cord Injury Rehabilitation 18.2 (2012), pp. 167–186.

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[3] A Catz. “Spinal Cord Independence Measure (SCIM)”. In: Encyclopedia of Clinical Neu-
ropsychology (2018), pp. 3258–3261.
[4] J Wright. “Functional independence measure”. In: Encyclopedia of Clinical Neuropsy-
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[5] P.V. Motika and D.C. Bergen. “Electroencephalography (EEG)”. In: Encyclopedia of
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[6] Alexander Ya. Kaplan, Andrew A. Fingelkurts, Alexander A. Fingelkurts, Sergei V.
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[7] C Belkhiria and V Peysakhovich. “Electro-Encephalography and Electro-Oculography
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Hereby I declare that I wrote the essay independently without using any sources or auxiliary
means other than the ones indicated.