Journal of Neural Engineering

Objective. Electroencephalography (EEG) analysis has been an important tool in neuroscience with applications in neuroscience, neural engineering (e.g. Brain–computer interfaces, BCI's), and even commercial applications. Many of the analytical tools used in EEG studies have used machine learning to uncover relevant information for neural classification and neuroimaging. Recently, the availability of large EEG data sets and advances in machine learning have both led to the deployment of deep learning architectures, especially in the analysis of EEG signals and in understanding the information it may contain for brain functionality. The robust automatic classification of these signals is an important step towards making the use of EEG more practical in many applications and less reliant on trained professionals. Towards this goal, a systematic review of the literature on deep learning applications to EEG classification was performed to address the following critical questions: (1) Which EEG classification tasks have been explored with deep learning? (2) What input formulations have been used for training the deep networks? (3) Are there specific deep learning network structures suitable for specific types of tasks? Approach. A systematic literature review of EEG classification using deep learning was performed on Web of Science and PubMed databases, resulting in 90 identified studies. Those studies were analyzed based on type of task, EEG preprocessing methods, input type, and deep learning architecture. Main results. For EEG classification tasks, convolutional neural networks, recurrent neural networks, deep belief networks outperform stacked auto-encoders and multi-layer perceptron neural networks in classification accuracy. The tasks that used deep learning fell into five general groups: emotion recognition, motor imagery, mental workload, seizure detection, event related potential detection, and sleep scoring. For each type of task, we describe the specific input formulation, major characteristics, and end classifier recommendations found through this review. Significance. This review summarizes the current practices and performance outcomes in the use of deep learning for EEG classification. Practical suggestions on the selection of many hyperparameters are provided in the hope that they will promote or guide the deployment of deep learning to EEG datasets in future research.

Context. Electroencephalography (EEG) is a complex signal and can require several years of training, as well as advanced signal processing and feature extraction methodologies to be correctly interpreted. Recently, deep learning (DL) has shown great promise in helping make sense of EEG signals due to its capacity to learn good feature representations from raw data. Whether DL truly presents advantages as compared to more traditional EEG processing approaches, however, remains an open question. Objective. In this work, we review 154 papers that apply DL to EEG, published between January 2010 and July 2018, and spanning different application domains such as epilepsy, sleep, brain–computer interfacing, and cognitive and affective monitoring. We extract trends and highlight interesting approaches from this large body of literature in order to inform future research and formulate recommendations. Methods. Major databases spanning the fields of science and engineering were queried to identify relevant studies published in scientific journals, conferences, and electronic preprint repositories. Various data items were extracted for each study pertaining to (1) the data, (2) the preprocessing methodology, (3) the DL design choices, (4) the results, and (5) the reproducibility of the experiments. These items were then analyzed one by one to uncover trends. Results. Our analysis reveals that the amount of EEG data used across studies varies from less than ten minutes to thousands of hours, while the number of samples seen during training by a network varies from a few dozens to several millions, depending on how epochs are extracted. Interestingly, we saw that more than half the studies used publicly available data and that there has also been a clear shift from intra-subject to inter-subject approaches over the last few years. About of the studies used convolutional neural networks (CNNs), while used recurrent neural networks (RNNs), most often with a total of 3–10 layers. Moreover, almost one-half of the studies trained their models on raw or preprocessed EEG time series. Finally, the median gain in accuracy of DL approaches over traditional baselines was across all relevant studies. More importantly, however, we noticed studies often suffer from poor reproducibility: a majority of papers would be hard or impossible to reproduce given the unavailability of their data and code. Significance. To help the community progress and share work more effectively, we provide a list of recommendations for future studies and emphasize the need for more reproducible research. We also make our summary table of DL and EEG papers available and invite authors of published work to contribute to it directly. A planned follow-up to this work will be an online public benchmarking portal listing reproducible results.

Objective. Most current electroencephalography (EEG)-based brain–computer interfaces (BCIs) are based on machine learning algorithms. There is a large diversity of classifier types that are used in this field, as described in our 2007 review paper. Now, approximately ten years after this review publication, many new algorithms have been developed and tested to classify EEG signals in BCIs. The time is therefore ripe for an updated review of EEG classification algorithms for BCIs. Approach. We surveyed the BCI and machine learning literature from 2007 to 2017 to identify the new classification approaches that have been investigated to design BCIs. We synthesize these studies in order to present such algorithms, to report how they were used for BCIs, what were the outcomes, and to identify their pros and cons. Main results. We found that the recently designed classification algorithms for EEG-based BCIs can be divided into four main categories: adaptive classifiers, matrix and tensor classifiers, transfer learning and deep learning, plus a few other miscellaneous classifiers. Among these, adaptive classifiers were demonstrated to be generally superior to static ones, even with unsupervised adaptation. Transfer learning can also prove useful although the benefits of transfer learning remain unpredictable. Riemannian geometry-based methods have reached state-of-the-art performances on multiple BCI problems and deserve to be explored more thoroughly, along with tensor-based methods. Shrinkage linear discriminant analysis and random forests also appear particularly useful for small training samples settings. On the other hand, deep learning methods have not yet shown convincing improvement over state-of-the-art BCI methods. Significance. This paper provides a comprehensive overview of the modern classification algorithms used in EEG-based BCIs, presents the principles of these methods and guidelines on when and how to use them. It also identifies a number of challenges to further advance EEG classification in BCI.

Objective. Although human induced pluripotent stem cell (iPSC)-derived cell replacement for Parkinson's disease has considerable reparative potential, its full therapeutic benefit is limited by poor graft survival and dopaminergic maturation. Injectable biomaterial scaffolds, such as collagen hydrogels, have the potential to address these issues via a plethora of supportive benefits including acting as a structural scaffold for cell adherence, shielding from the host immune response and providing a reservoir of neurotrophic factors to aid survival and differentiation. Thus, the aim of this study was to determine if a neurotrophin-enriched collagen hydrogel could improve the survival and maturation of iPSC-derived dopaminergic progenitors (iPSC-DAPs) after transplantation into the rat parkinsonian brain. Approach. Human iPSC-DAPs were transplanted into the 6-hydroxydopamine-lesioned striatum either alone, with the neurotrophins GDNF and BDNF, in an unloaded collagen hydrogel, or in a neurotrophin-loaded collagen hydrogel. Post-mortem, human nuclear immunostaining was used to identify surviving iPSC-DAPs while tyrosine hydroxylase immunostaining was used to identify iPSC-DAPs that had differentiated into mature dopaminergic neurons. Main results. We found that iPSC-DAPs transplanted in the neurotrophin-enriched collagen hydrogel survived and matured significantly better than cells implanted without the biomaterial (8 fold improvement in survival and 16 fold improvement in dopaminergic differentiation). This study shows that transplantation of human iPSC-DAPs in a neurotrophin-enriched collagen hydrogel improves graft survival and maturation in the parkinsonian rat brain. Significance. The data strongly supports further investigation of supportive hydrogels for improving the outcome of iPSC-derived brain repair in Parkinson's disease.

Objective. Brain–computer interfaces (BCI) enable direct communication with a computer, using neural activity as the control signal. This neural signal is generally chosen from a variety of well-studied electroencephalogram (EEG) signals. For a given BCI paradigm, feature extractors and classifiers are tailored to the distinct characteristics of its expected EEG control signal, limiting its application to that specific signal. Convolutional neural networks (CNNs), which have been used in computer vision and speech recognition to perform automatic feature extraction and classification, have successfully been applied to EEG-based BCIs; however, they have mainly been applied to single BCI paradigms and thus it remains unclear how these architectures generalize to other paradigms. Here, we ask if we can design a single CNN architecture to accurately classify EEG signals from different BCI paradigms, while simultaneously being as compact as possible. Approach. In this work we introduce EEGNet, a compact convolutional neural network for EEG-based BCIs. We introduce the use of depthwise and separable convolutions to construct an EEG-specific model which encapsulates well-known EEG feature extraction concepts for BCI. We compare EEGNet, both for within-subject and cross-subject classification, to current state-of-the-art approaches across four BCI paradigms: P300 visual-evoked potentials, error-related negativity responses (ERN), movement-related cortical potentials (MRCP), and sensory motor rhythms (SMR). Main results. We show that EEGNet generalizes across paradigms better than, and achieves comparably high performance to, the reference algorithms when only limited training data is available across all tested paradigms. In addition, we demonstrate three different approaches to visualize the contents of a trained EEGNet model to enable interpretation of the learned features. Significance. Our results suggest that EEGNet is robust enough to learn a wide variety of interpretable features over a range of BCI tasks. Our models can be found at: https://github.com/vlawhern/arl-eegmodels.

Stroke is one of the leading causes of long-term disability among adults and contributes to major socio-economic burden globally. Stroke frequently results in multifaceted impairments including motor, cognitive and emotion deficits. In recent years, brain–computer interface (BCI)-based therapy has shown promising results for post-stroke motor rehabilitation. In spite of the success received by BCI-based interventions in the motor domain, non-motor impairments are yet to receive similar attention in research and clinical settings. Some preliminary encouraging results in post-stroke cognitive rehabilitation using BCI seem to suggest that it may also hold potential for treating non-motor deficits such as cognitive and emotion impairments. Moreover, past studies have shown an intricate relationship between motor, cognitive and emotion functions which might influence the overall post-stroke rehabilitation outcome. A number of studies highlight the inability of current treatment protocols to account for the implicit interplay between motor, cognitive and emotion functions. This indicates the necessity to explore an all-inclusive treatment plan targeting the synergistic influence of these standalone interventions. This approach may lead to better overall recovery than treating the individual deficits in isolation. In this paper, we review the recent advances in BCI-based post-stroke motor rehabilitation and highlight the potential for the use of BCI systems beyond the motor domain, in particular, in improving cognition and emotion of stroke patients. Building on the current results and findings of studies in individual domains, we next discuss the possibility of a holistic BCI system for motor, cognitive and affect rehabilitation which may synergistically promote restorative neuroplasticity. Such a system would provide an all-encompassing rehabilitation platform, leading to overarching clinical outcomes and transfer of these outcomes to a better quality of living. This is one of the first works to analyse the possibility of targeting cross-domain influence of post-stroke functional recovery enabled by BCI-based rehabilitation.

Neuromorphic computing covers a diverse range of approaches to information processing all of which demonstrate some degree of neurobiological inspiration that differentiates them from mainstream conventional computing systems. The philosophy behind neuromorphic computing has its origins in the seminal work carried out by Carver Mead at Caltech in the late 1980s. This early work influenced others to carry developments forward, and advances in VLSI technology supported steady growth in the scale and capability of neuromorphic devices. Recently, a number of large-scale neuromorphic projects have emerged, taking the approach to unprecedented scales and capabilities. These large-scale projects are associated with major new funding initiatives for brain-related research, creating a sense that the time and circumstances are right for progress in our understanding of information processing in the brain. In this review we present a brief history of neuromorphic engineering then focus on some of the principal current large-scale projects, their main features, how their approaches are complementary and distinct, their advantages and drawbacks, and highlight the sorts of capabilities that each can deliver to neural modellers.

Facial paralysis is the inability to move facial muscles thereby impairing the ability to blink and make facial expressions. Depending on the localization of the nerve malfunction it is subcategorised into central or peripheral and is usually unilateral. This leads to health deficits stemming from corneal dryness and social ostracization. Objective: Electrical stimulation shows promise as a method through which to restore the blink function and as a result improve eye health. However, it is unknown whether a real-time, myoelectrically controlled, neurostimulating device can be used as assistance to this pathological condition. Approach: We developed NEURO-BLINK, a wearable robotic system, that can detect the volitional healthy contralateral blink through electromyography and electrically stimulate the impaired subcutaneous facial nerve and orbicularis oculi muscle to compensate for lost blink function. Alongside the system, we developed a method to evaluate optimal electrode placement through the relationship between blink amplitude and injected charge. Main results: Ten patients with unilateral facial palsy were enrolled in the NEURO-BLINK study, with eight completing testing under two conditions. (1) where the stimulation was cued with an auditory signal (i.e. paced controlled) and (2) synchronized with the natural blink (i.e. myoelectrically controlled). In both scenarios, overall eye closure (distance between eyelids) and cornea coverage measured with high FPS video were found to significantly improve when measured in real-time, while no significant clinical changes were found immediately after use. Significance: This work takes steps towards the development of a portable medical device for blink restoration and facial stimulation which has the potential to improve long-term ocular health.

Objective. Deep learning (DL) networks are increasingly attracting attention across various fields, including electroencephalography (EEG) signal processing. These models provide comparable performance to that of traditional techniques. At present, however, there is a lack of well-structured and standardized datasets with specific benchmark limit the development of DL solutions for EEG denoising. Approach. Here, we present EEGdenoiseNet, a benchmark EEG dataset that is suited for training and testing DL-based denoising models, as well as for performance comparisons across models. EEGdenoiseNet contains 4514 clean EEG segments, 3400 ocular artifact segments and 5598 muscular artifact segments, allowing users to synthesize contaminated EEG segments with the ground-truth clean EEG. Main results. We used EEGdenoiseNet to evaluate denoising performance of four classical networks (a fully-connected network, a simple and a complex convolution network, and a recurrent neural network). Our results suggested that DL methods have great potential for EEG denoising even under high noise contamination. Significance. Through EEGdenoiseNet, we hope to accelerate the development of the emerging field of DL-based EEG denoising. The dataset and code are available at https://github.com/ncclabsustech/EEGdenoiseNet.

Objective. Brain-computer interface (BCI) aims to establish communication paths between the brain processes and external devices. Different methods have been used to extract human intentions from electroencephalography (EEG) recordings. Those based on motor imagery (MI) seem to have a great potential for future applications. These approaches rely on the extraction of EEG distinctive patterns during imagined movements. Techniques able to extract patterns from raw signals represent an important target for BCI as they do not need labor-intensive data pre-processing. Approach. We propose a new approach based on a 10-layer one-dimensional convolution neural network (1D-CNN) to classify five brain states (four MI classes plus a 'baseline' class) using a data augmentation algorithm and a limited number of EEG channels. In addition, we present a transfer learning method used to extract critical features from the EEG group dataset and then to customize the model to the single individual by training its late layers with only 12-min individual-related data. Main results. The model tested with the 'EEG Motor Movement/Imagery Dataset' outperforms the current state-of-the-art models by achieving a ${99.38\%}$ accuracy at the group level. In addition, the transfer learning approach we present achieves an average accuracy of ${99.46\%}$. Significance. The proposed methods could foster the development of future BCI applications relying on few-channel portable recording devices and individual-based training.

Objective: Epilepsy is a complex disease spanning across multiple scales, from ion channels in neurons to neuronal circuits across the entire brain. Over the past decades, computational models have been used to describe the pathophysiological activity of the epileptic brain from different aspects. Traditionally, each computational model can aid in optimizing therapeutic interventions, therefore, providing a particular view to design strategies for treating epilepsy. As a result, most studies are concerned with generating specific models of the epileptic brain that can help us understand the certain machinery of the pathological state. Those specific models vary in complexity and biological accuracy, with system-level models often lacking biological details. Approach: Here, we review various types of computational model of epilepsy and discuss their potential for different therapeutic approaches and scenarios, including drug discovery, surgical strategies, brain stimulation, and seizure prediction. We propose that we need to consider an integrated approach with a unified modelling framework across multiple scales to understand the epileptic brain. Our proposal is based on the recent increase in computational power, which has opened up the possibility of unifying those specific epileptic models into simulations with an unprecedented level of detail. Main results: A multi-scale epilepsy model can bridge the gap between biologically detailed models, used to address molecular and cellular questions, and brain-wide models based on abstract models which can account for complex neurological and behavioural observations. Significance: With these efforts, we move toward the next generation of epileptic brain models capable of connecting cellular features, such as ion channel properties, with standard clinical measures such as seizure severity.

Objective. Artificial neural networks (ANNs) are state-of-the-art tools for modeling and decoding neural activity, but deploying them in closed-loop experiments with tight timing constraints is challenging due to their limited support in existing real-time frameworks. Researchers need a platform that fully supports high-level languages for running ANNs (e.g. Python and Julia) while maintaining support for languages that are critical for low-latency data acquisition and processing (e.g. C and C++). Approach. To address these needs, we introduce the Backend for Realtime Asynchronous Neural Decoding (BRAND). BRAND comprises Linux processes, termed nodes, which communicate with each other in a graph via streams of data. Its asynchronous design allows for acquisition, control, and analysis to be executed in parallel on streams of data that may operate at different timescales. BRAND uses Redis, an in-memory database, to send data between nodes, which enables fast inter-process communication and supports 54 different programming languages. Thus, developers can easily deploy existing ANN models in BRAND with minimal implementation changes. Main results. In our tests, BRAND achieved <600 microsecond latency between processes when sending large quantities of data (1024 channels of 30 kHz neural data in 1 ms chunks). BRAND runs a brain-computer interface with a recurrent neural network (RNN) decoder with less than 8 ms of latency from neural data input to decoder prediction. In a real-world demonstration of the system, participant T11 in the BrainGate2 clinical trial (ClinicalTrials.gov Identifier: NCT00912041) performed a standard cursor control task, in which 30 kHz signal processing, RNN decoding, task control, and graphics were all executed in BRAND. This system also supports real-time inference with complex latent variable models like Latent Factor Analysis via Dynamical Systems. Significance. By providing a framework that is fast, modular, and language-agnostic, BRAND lowers the barriers to integrating the latest tools in neuroscience and machine learning into closed-loop experiments.

Objective. The auditory steady-state response (ASSR) allows estimation of hearing thresholds. The ASSR can be estimated from electroencephalography (EEG) recordings from electrodes positioned on both the scalp and within the ear (ear-EEG). Ear-EEG can potentially be integrated into hearing aids, which would enable automatic fitting of the hearing device in daily life. The conventional stimuli for ASSR-based hearing assessment, such as pure tones and chirps, are monotonous and tiresome, making them inconvenient for repeated use in everyday situations. In this study we investigate the use of natural speech sounds for ASSR estimation. Approach. EEG was recorded from 22 normal hearing subjects from both scalp and ear electrodes. Subjects were stimulated monaurally with 180 min of speech stimulus modified by applying a 40 Hz amplitude modulation (AM) to an octave frequency sub-band centered at 1 kHz. Each 50 ms sub-interval in the AM sub-band was scaled to match one of 10 pre-defined levels (0–45 dB sensation level, 5 dB steps). The apparent latency for the ASSR was estimated as the maximum average cross-correlation between the envelope of the AM sub-band and the recorded EEG and was used to align the EEG signal with the audio signal. The EEG was then split up into sub-epochs of 50 ms length and sorted according to the stimulation level. ASSR was estimated for each level for both scalp- and ear-EEG. Main results. Significant ASSRs with increasing amplitude as a function of presentation level were recorded from both scalp and ear electrode configurations. Significance. Utilizing natural sounds in ASSR estimation offers the potential for electrophysiological hearing assessment that are more comfortable and less fatiguing compared to existing ASSR methods. Combined with ear-EEG, this approach may allow convenient hearing threshold estimation in everyday life, utilizing ambient sounds. Additionally, it may facilitate both initial fitting and subsequent adjustments of hearing aids outside of clinical settings.

Objective. Electrical neuromodulation is an established non-pharmacological treatment for chronic pain. However, existing devices using pulsatile stimulation typically inhibit pain pathways indirectly and are not suitable for all types of chronic pain. Direct current (DC) stimulation is a recently developed technology which affects small-diameter fibres more strongly than pulsatile stimulation. Since nociceptors are predominantly small-diameter Aδ and C fibres, we investigated if this property could be applied to preferentially reduce nociceptive signalling. Approach. We applied a DC waveform to the sciatic nerve in rats of both sexes and recorded multi-unit spinal activity evoked at the hindpaw using various natural stimuli corresponding to different sensory modalities rather than broad-spectrum electrical stimulus. To determine if DC neuromodulation is effective across different types of chronic pain, tests were performed in models of neuropathic and inflammatory pain. Main results. We found that in both pain models tested, DC application reduced responses evoked by noxious stimuli, as well as tactile-evoked responses which we suggest may be involved in allodynia. Different spinal activity of different modalities were reduced in naïve animals compared to the pain models, indicating that physiological changes such as those mediated by disease states could play a larger role than previously thought in determining neuromodulation outcomes. Significance. Our findings support the continued development of DC neuromodulation as a method for reduction of nociceptive signalling, and suggests that it may be effective at treating a broader range of aberrant pain conditions than existing devices.

Objective. The instability of the EEG acquisition devices may lead to information loss in the channels or frequency bands of the collected EEG. This phenomenon may be ignored in available models, which leads to the overfitting and low generalization of the model. Approach. Multiple self-supervised learning tasks are introduced in the proposed model to enhance the generalization of EEG emotion recognition and reduce the overfitting problem to some extent. Firstly, channel masking and frequency masking are introduced to simulate the information loss in certain channels and frequency bands resulting from the instability of EEG, and two self-supervised learning-based feature reconstruction tasks combining masked graph autoencoders (GAE) are constructed to enhance the generalization of the shared encoder. Secondly, to take full advantage of the complementary information contained in these two self-supervised learning tasks to ensure the reliability of feature reconstruction, a weight sharing (WS) mechanism is introduced between the two graph decoders. Thirdly, an adaptive weight multi-task loss (AWML) strategy based on homoscedastic uncertainty is adopted to combine the supervised learning loss and the two self-supervised learning losses to enhance the performance further. Main results. Experimental results on SEED, SEED-V, and DEAP datasets demonstrate that: (i) Generally, the proposed model achieves higher averaged emotion classification accuracy than various baselines included in both subject-dependent and subject-independent scenarios. (ii) Each key module contributes to the performance enhancement of the proposed model. (iii) It achieves higher training efficiency, and significantly lower model size and computational complexity than the state-of-the-art (SOTA) multi-task-based model. (iv) The performances of the proposed model are less influenced by the key parameters. Significance. The introduction of the self-supervised learning task helps to enhance the generalization of the EEG emotion recognition model and eliminate overfitting to some extent, which can be modified to be applied in other EEG-based classification tasks.

Objective: Epilepsy is a complex disease spanning across multiple scales, from ion channels in neurons to neuronal circuits across the entire brain. Over the past decades, computational models have been used to describe the pathophysiological activity of the epileptic brain from different aspects. Traditionally, each computational model can aid in optimizing therapeutic interventions, therefore, providing a particular view to design strategies for treating epilepsy. As a result, most studies are concerned with generating specific models of the epileptic brain that can help us understand the certain machinery of the pathological state. Those specific models vary in complexity and biological accuracy, with system-level models often lacking biological details. Approach: Here, we review various types of computational model of epilepsy and discuss their potential for different therapeutic approaches and scenarios, including drug discovery, surgical strategies, brain stimulation, and seizure prediction. We propose that we need to consider an integrated approach with a unified modelling framework across multiple scales to understand the epileptic brain. Our proposal is based on the recent increase in computational power, which has opened up the possibility of unifying those specific epileptic models into simulations with an unprecedented level of detail. Main results: A multi-scale epilepsy model can bridge the gap between biologically detailed models, used to address molecular and cellular questions, and brain-wide models based on abstract models which can account for complex neurological and behavioural observations. Significance: With these efforts, we move toward the next generation of epileptic brain models capable of connecting cellular features, such as ion channel properties, with standard clinical measures such as seizure severity.

Objective. Brain-computer interfaces (BCIs) are neuroprosthetic devices that allow for direct interaction between brains and machines. These types of neurotechnologies have recently experienced a strong drive in research and development, given, in part, that they promise to restore motor and communication abilities in individuals experiencing severe paralysis. While a rich literature analyzes the ethical, legal, and sociocultural implications (ELSCI) of these novel neurotechnologies, engineers, clinicians and BCI practitioners often do not have enough exposure to these topics. Approach. Here, we present the IEEE Neuroethics Framework, an international, multiyear, iterative initiative aimed at developing a robust, accessible set of considerations for diverse stakeholders. Main results. Using the framework, we provide practical examples of ELSCI considerations for BCI neurotechnologies. We focus on invasive technologies, and in particular, devices that are implanted intra-cortically for medical research applications. Significance. We demonstrate the utility of our framework in exposing a wide range of implications across different intra-cortical BCI technology modalities and conclude with recommendations on how to utilize this knowledge in the development and application of ethical guidelines for BCI neurotechnologies.

Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients. Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles. Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment. Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.

Deep brain stimulation (DBS) using Medtronic's Percept™ PC implantable pulse generator is FDA-approved for treating Parkinson's disease (PD), essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Percept™ PC enables simultaneous recording of neural signals from the same lead used for stimulation. Many Percept™ PC sensing features were built with PD patients in mind, but these features are potentially useful to refine therapies for many different disease processes. When starting our ongoing epilepsy research study, we found it difficult to find detailed descriptions about these features and have compiled information from multiple sources to understand it as a tool, particularly for use in patients other than those with PD. Here we provide a tutorial for scientists and physicians interested in using Percept™ PC's features and provide examples of how neural time series data is often represented and saved. We address characteristics of the recorded signals and discuss Percept™ PC hardware and software capabilities in data pre-processing, signal filtering, and DBS lead performance. We explain the power spectrum of the data and how it is shaped by the filter response of Percept™ PC as well as the aliasing of the stimulation due to digitally sampling the data. We present Percept™ PC's ability to extract biomarkers that may be used to optimize stimulation therapy. We show how differences in lead type affects noise characteristics of the implanted leads from seven epilepsy patients enrolled in our clinical trial. Percept™ PC has sufficient signal-to-noise ratio, sampling capabilities, and stimulus artifact rejection for neural activity recording. Limitations in sampling rate, potential artifacts during stimulation, and shortening of battery life when monitoring neural activity at home were observed. Despite these limitations, Percept™ PC demonstrates potential as a useful tool for recording neural activity in order to optimize stimulation therapies to personalize treatment.

Peripheral nerve interfaces (PNIs) are electrical systems designed to integrate with peripheral nerves in patients, such as following central nervous system (CNS) injuries to augment or replace CNS control and restore function. We review the literature for clinical trials and studies containing clinical outcome measures to explore the utility of human applications of PNIs. We discuss the various types of electrodes currently used for PNI systems and their functionalities and limitations. We discuss important design characteristics of PNI systems, including biocompatibility, resolution and specificity, efficacy, and longevity, to highlight their importance in the current and future development of PNIs. The clinical outcomes of PNI systems are also discussed. Finally, we review relevant PNI clinical trials that were conducted, up to the present date, to restore the sensory and motor function of upper or lower limbs in amputees, spinal cord injury patients, or intact individuals and describe their significant findings. This review highlights the current progress in the field of PNIs and serves as a foundation for future development and application of PNI systems.

Objective. Intracellular patch-clamp electrophysiology, one of the most ubiquitous, high-fidelity techniques in biophysics, remains laborious and low-throughput. While previous efforts have succeeded at automating some steps of the technique, here we demonstrate a robotic 'PatcherBot' system that can perform many patch-clamp recordings sequentially, fully unattended. Approach. Comprehensive automation is accomplished by outfitting the robot with machine vision, and cleaning pipettes instead of manually exchanging them. Main results. the PatcherBot can obtain data at a rate of 16 cells per hour and work with no human intervention for up to 3 h. We demonstrate the broad applicability and scalability of this system by performing hundreds of recordings in tissue culture cells and mouse brain slices with no human supervision. Using the PatcherBot, we also discovered that pipette cleaning can be improved by a factor of three. Significance. The system is potentially transformative for applications that depend on many high-quality measurements of single cells, such as drug screening, protein functional characterization, and multimodal cell type investigations.

Objective. Most brain–computer interfaces (BCIs) based on functional near-infrared spectroscopy (fNIRS) require that users perform mental tasks such as motor imagery, mental arithmetic, or music imagery to convey a message or to answer simple yes or no questions. These cognitive tasks usually have no direct association with the communicative intent, which makes them difficult for users to perform. Approach. In this paper, a 3-class intuitive BCI is presented which enables users to directly answer yes or no questions by covertly rehearsing the word 'yes' or 'no' for 15 s. The BCI also admits an equivalent duration of unconstrained rest which constitutes the third discernable task. Twelve participants each completed one offline block and six online blocks over the course of two sessions. The mean value of the change in oxygenated hemoglobin concentration during a trial was calculated for each channel and used to train a regularized linear discriminant analysis (RLDA) classifier. Main results. By the final online block, nine out of 12 participants were performing above chance (p  <  0.001 using the binomial cumulative distribution), with a 3-class accuracy of 83.8%  ±  9.4%. Even when considering all participants, the average online 3-class accuracy over the last three blocks was 64.1 %  ±  20.6%, with only three participants scoring below chance (p  <  0.001). For most participants, channels in the left temporal and temporoparietal cortex provided the most discriminative information. Significance. To our knowledge, this is the first report of an online 3-class imagined speech BCI. Our findings suggest that imagined speech can be used as a reliable activation task for selected users for development of more intuitive BCIs for communication.

Objective. Optical techniques for recording and manipulating neural activity have traditionally been constrained to superficial brain regions due to light scattering. New techniques are needed to extend optical access to large 3D volumes in deep brain areas, while retaining local connectivity. Approach. We have developed a method to implant bundles of hundreds or thousands of optical microfibers, each with a diameter of 8 μm. During insertion, each fiber moves independently, following a path of least resistance. The fibers achieve near total internal reflection, enabling optically interfacing with the tissue near each fiber aperture. Main results. At a depth of 3 mm, histology shows fibers consistently splay over 1 mm in diameter throughout the target region. Immunohistochemical staining after chronic implants reveals neurons in close proximity to the fiber tips. Models of photon fluence indicate that fibers can be used as a stimulation light source to precisely activate distinct patterns of neurons by illuminating a subset of fibers in the bundle. By recording fluorescent beads diffusing in water, we demonstrate the recording capability of the fibers. Significance. Our histology, modeling and fluorescent bead recordings suggest that the optical microfibers may provide a minimally invasive, stable, bidirectional interface for recording or stimulating genetic probes in deep brain regions—a hyper-localized form of fiber photometry.

Objective. Stereotactic frame systems are the gold-standard for stereotactic surgeries, such as implantation of deep brain stimulation (DBS) devices for treatment of medically resistant neurologic and psychiatric disorders. However, frame-based systems require that the patient is awake with a stereotactic frame affixed to their head for the duration of the surgical planning and implantation of the DBS electrodes. While frameless systems are increasingly available, a reusable re-attachable frame system provides unique benefits. As such, we created a novel reusable MRI-compatible stereotactic frame system that maintains clinical accuracy through the detachment and reattachment of its stereotactic devices used for MRI-guided neuronavigation. Approach. We designed a reusable arc-centered frame system that includes MRI-compatible anchoring skull screws for detachment and re-attachment of its stereotactic devices. We validated the stability and accuracy of our system through phantom, in vivo mock-human porcine DBS-model and human cadaver testing. Main results. Phantom testing achieved a root mean square error (RMSE) of 0.94  ±  0.23 mm between the ground truth and the frame-targeted coordinates; and achieved an RMSE of 1.11  ±  0.40 mm and 1.33  ±  0.38 mm between the ground truth and the CT- and MRI-targeted coordinates, respectively. In vivo and cadaver testing achieved a combined 3D Euclidean localization error of 1.85  ±  0.36 mm (p  <  0.03) between the pre-operative MRI-guided placement and the post-operative CT-guided confirmation of the DBS electrode. Significance. Our system demonstrated consistent clinical accuracy that is comparable to conventional frame and frameless stereotactic systems. Our frame system is the first to demonstrate accurate relocation of stereotactic frame devices during in vivo MRI-guided DBS surgical procedures. As such, this reusable and re-attachable MRI-compatible system is expected to enable more complex, chronic neuromodulation experiments, and lead to a clinically available re-attachable frame that is expected to decrease patient discomfort and costs of DBS surgery.

Objective. Cochlear implants, while providing significant benefits to recipients, remain limited due to broad neural activation. Focussed multipolar stimulation (FMP) is an advanced stimulation strategy that uses multiple current sources to produce highly focussed patterns of neural excitation in order to overcome these shortcomings. Approach. This report presents single-source multipolar stimulation (SSMPS), a novel form of stimulation based on a single current source and a passive current divider. Compared to conventional FMP with multiple current sources, SSMPS can be implemented as a modular addition to conventional (i.e. single) current source stimulation systems facilitating charge balance within the cochlea. As with FMP, SSMPS requires the determination of a transimpedance matrix to allow for focusing of the stimulation. The first part of this study therefore investigated the effects of varying the probe stimulus (e.g. current level and pulse width) on the measurement of the transimpedance matrix. SSMPS was then studied using in vitro based measurements of voltages at non-stimulated electrodes along an electrode array in normal saline. The voltage reduction with reference to monopolar stimulation was compared to tripolar and common ground stimulation, two clinically established stimulation modes. Finally, a proof of principle in vivo test of SSMPS in a feline model was performed. Main results. A probe stimulus of at least 40 nC is required to reliably measure the transimpedance matrix. In vitro stimulation using SSMPS resulted in a significantly greater voltage reduction compared to monopolar, tripolar and common ground stimulation. Interestingly, matching measurement and stimulation parameters did not lead to an improved focussing performance. Compared to monopolar stimulation, SSMPS resulted in reduced spread of neural activity in the inferior colliculus, albeit with increased thresholds. Significance. The present study demonstrates that SSMPS successfully limits the broadening of the excitatory field along the electrode array and a subsequent reduction in the spread of neural excitation.

Purpose:&#xD;Brain-Computer Interfaces (BCIs) have the potential to reinstate lost communication faculties. Results from speech decoding studies indicate that a usable speech BCI based on activity in the sensorimotor cortex (SMC) can be achieved using subdurally implanted electrodes. However, the optimal characteristics for a successful speech implant are largely unknown. We address this topic in a high field blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) study, by assessing the decodability of spoken words as a function of hemisphere, gyrus, sulcal depth, and position along the ventral/dorsal-axis.&#xD;Methods:&#xD;Twelve subjects conducted a 7T fMRI experiment in which they pronounced 6 different pseudo-words over 6 runs. We divided the SMC by hemisphere, gyrus, sulcal depth, and position along the ventral/dorsal axis. Classification was performed on in these SMC areas using multiclass Support Vector Machine (SVM).&#xD;Results:&#xD;Significant classification was possible from the SMC, but no preference for the left or right hemisphere, nor for the precentral or postcentral gyrus for optimal word classification was detected. Classification while using information from the cortical surface was slightly better than when using information from deep in the central sulcus, and was highest within the ventral 50% of SMC. Confusion matrices where highly similar across the entire SMC. An SVM-searchlight analysis revealed significant classification in the superior temporal gyrus in addition to the SMC.&#xD;Conclusion:&#xD;The current results support a unilateral implant using surface electrodes, covering the ventral 50% of the SMC. The added value of depth electrodes is unclear. We did not observe evidence for variations in the qualitative nature of information across SMC. The current results need to be confirmed in paralyzed patients performing attempted speech.

Objective. Our goal is to decode firing patterns of single neurons in the left ventralis intermediate nucleus (Vim) of the thalamus, related to speech production, perception, and imagery. For realistic speech brain-machine interfaces (BMIs), we aim to characterize the amount of thalamic neurons necessary for high accuracy decoding.&#xD;Approach. We intraoperatively recorded single neuron activity in the left Vim of 8 neurosurgical patients undergoing implantation of deep brain stimulator or RF lesioning during production, perception and imagery of the five monophthongal vowel sounds. We utilized the Spade decoder, a machine learning algorithm that dynamically learns specific features of firing patterns and is based on sparse decomposition of the high dimensional feature space.&#xD;Main results. Spade outperformed all algorithms compared with, for all three aspects of speech: production, perception and imagery, and obtained accuracies of 100%, 96%, and 92%, respectively (chance level: 20%) based on pooling together neurons across all patients. The accuracy was logarithmic in the amount of neurons for all three aspects of speech. Regardless of the amount of units employed, production gained highest accuracies, whereas perception and imagery equated with each other.&#xD;Significance. Our research renders single neuron activity in the left Vim a promising source of inputs to BMIs for restoration of speech faculties for locked-in patients or patients with anarthria or dysarthria to allow them to communicate again. Our characterization of how many neurons are necessary to achieve a certain decoding accuracy is of utmost importance for planning BMI implantation.&#xD;

Objective:&#xD;Invasive brain-computer interfaces (BCIs) are promising communication devices for severely paralyzed patients. Recent advances in intracranial electroencephalography (iEEG) coupled with natural language processing have enhanced communication speed and accuracy. It should be noted that such a speech BCI uses signals from the motor cortex. However, BCIs based on motor cortical activities may experience signal deterioration in users with motor cortical degenerative diseases such as amyotrophic lateral sclerosis (ALS). An alternative approach to using iEEG of the motor cortex is necessary to support patients with such conditions.&#xD;Approach:&#xD;In this study, a multimodal embedding of text and images was used to decode visual semantic information from iEEG signals of the visual cortex to generate text and images. We used contrastive language-image pretraining (CLIP) embedding to represent images presented to 17 patients implanted with electrodes in the occipital and temporal cortexes. A CLIP image vector was inferred from the high-γ power of the iEEG signals recorded while viewing the images.&#xD;Main results:&#xD;Text was generated by CLIPCAP from the inferred CLIP vector with better-than-chance accuracy. Then, an image was created from the generated text using StableDiffusion with significant accuracy.&#xD;Significance:&#xD;The text and images generated from iEEG through the CLIP embedding vector can be used for improved communication.&#xD;

Objective: Traditional quantification of fluorescence signals, such as&#xD;∆F/F, relies on ratiometric measures that necessitate a baseline for compar-&#xD;ison, limiting their applicability in dynamic analyses. Our goal here is to&#xD;develop a baseline-independent method for analyzing fluorescence data that&#xD;fully exploits temporal dynamics to introduce a novel approach for dynami-&#xD;cal super-resolution analysis, including in subcellular resolution.&#xD;Approach: We introduce ARES (Autoregressive RESiduals), a novel method&#xD;that leverages the temporal aspect of fluorescence signals. By focusing on&#xD;the quantification of residuals following linear autoregression, ARES obviates&#xD;the need for a predefined baseline, enabling a more nuanced analysis of signal&#xD;dynamics.&#xD;Main Result: We delineate the foundational attributes of ARES, illustrat-&#xD;ing its capability to enhance both spatial and temporal resolution of calcium&#xD;fluorescence activity beyond the conventional ratiometric measure (∆F/F).&#xD;Additionally, we demonstrate ARES's utility in elucidating intracellular cal-&#xD;cium dynamics through the detailed observation of calcium wave propagation&#xD;within a dendrite.&#xD;Significance: ARES stands out as a robust and precise tool for the quan-&#xD;tification of fluorescence signals, adept at analyzing both spontaneous and&#xD;evoked calcium dynamics. Its ability to facilitate the subcellular localiza-&#xD;tion of calcium signals and the spatiotemporal tracking of calcium dynam-&#xD;ics—where traditional ratiometric measures falter—underscores its potential&#xD;to revolutionize baseline-independent analyses in the field

Objective. Brain-computer interface (BCI) systems with large directly accessible instruction sets are one of the difficulties in BCI research. Research to achieve high target resolution (≥ 100) has not yet entered a rapid development stage, which contradicts the application requirements. Steady-state visual evoked potential (SSVEP) based BCIs have an advantage in terms of the number of targets, but the competitive mechanism between the target stimulus and its neighboring stimuli is a key challenge that prevents the target resolution from being improved significantly. Approach. In this paper, we reverse the competitive mechanism and propose a frequency spatial multiplexing method to produce more targets with limited frequencies. In the proposed paradigm, we replicated each flicker stimulus as a 2×2 matrix and arrange the matrices of all frequencies in a tiled fashion to form the interaction interface. With different arrangements, we designed and tested three example paradigms with different layouts. Further we designed a graph neural network that distinguishes between targets of the same frequency by recognizing the different electroencephalography (EEG) response distribution patterns evoked by each target and its neighboring targets. Main results. Extensive experiment studies employing eleven subjects have been performed to verify the validity of the proposed method. The average classification accuracies in the offline validation experiments for the three paradigms are 89.16%, 91.38%, and 87.90%, with information transfer rates (ITR) of 51.66, 53.96, and 50.55 bits/min, respectively. Significance. This study utilized the positional relationship between stimuli and did not circumvent the competing response problem. Therefore, other state-of-the-art methods focusing on enhancing the efficiency of SSVEP detection can be used as a basis for the present method to achieve very promising improvements.

Objective. Artificial neural networks (ANNs) are state-of-the-art tools for modeling and decoding neural activity, but deploying them in closed-loop experiments with tight timing constraints is challenging due to their limited support in existing real-time frameworks. Researchers need a platform that fully supports high-level languages for running ANNs (e.g. Python and Julia) while maintaining support for languages that are critical for low-latency data acquisition and processing (e.g. C and C++). Approach. To address these needs, we introduce the Backend for Realtime Asynchronous Neural Decoding (BRAND). BRAND comprises Linux processes, termed nodes, which communicate with each other in a graph via streams of data. Its asynchronous design allows for acquisition, control, and analysis to be executed in parallel on streams of data that may operate at different timescales. BRAND uses Redis, an in-memory database, to send data between nodes, which enables fast inter-process communication and supports 54 different programming languages. Thus, developers can easily deploy existing ANN models in BRAND with minimal implementation changes. Main results. In our tests, BRAND achieved <600 microsecond latency between processes when sending large quantities of data (1024 channels of 30 kHz neural data in 1 ms chunks). BRAND runs a brain-computer interface with a recurrent neural network (RNN) decoder with less than 8 ms of latency from neural data input to decoder prediction. In a real-world demonstration of the system, participant T11 in the BrainGate2 clinical trial (ClinicalTrials.gov Identifier: NCT00912041) performed a standard cursor control task, in which 30 kHz signal processing, RNN decoding, task control, and graphics were all executed in BRAND. This system also supports real-time inference with complex latent variable models like Latent Factor Analysis via Dynamical Systems. Significance. By providing a framework that is fast, modular, and language-agnostic, BRAND lowers the barriers to integrating the latest tools in neuroscience and machine learning into closed-loop experiments.

Objective. The auditory steady-state response (ASSR) allows estimation of hearing thresholds. The ASSR can be estimated from electroencephalography (EEG) recordings from electrodes positioned on both the scalp and within the ear (ear-EEG). Ear-EEG can potentially be integrated into hearing aids, which would enable automatic fitting of the hearing device in daily life. The conventional stimuli for ASSR-based hearing assessment, such as pure tones and chirps, are monotonous and tiresome, making them inconvenient for repeated use in everyday situations. In this study we investigate the use of natural speech sounds for ASSR estimation. Approach. EEG was recorded from 22 normal hearing subjects from both scalp and ear electrodes. Subjects were stimulated monaurally with 180 min of speech stimulus modified by applying a 40 Hz amplitude modulation (AM) to an octave frequency sub-band centered at 1 kHz. Each 50 ms sub-interval in the AM sub-band was scaled to match one of 10 pre-defined levels (0–45 dB sensation level, 5 dB steps). The apparent latency for the ASSR was estimated as the maximum average cross-correlation between the envelope of the AM sub-band and the recorded EEG and was used to align the EEG signal with the audio signal. The EEG was then split up into sub-epochs of 50 ms length and sorted according to the stimulation level. ASSR was estimated for each level for both scalp- and ear-EEG. Main results. Significant ASSRs with increasing amplitude as a function of presentation level were recorded from both scalp and ear electrode configurations. Significance. Utilizing natural sounds in ASSR estimation offers the potential for electrophysiological hearing assessment that are more comfortable and less fatiguing compared to existing ASSR methods. Combined with ear-EEG, this approach may allow convenient hearing threshold estimation in everyday life, utilizing ambient sounds. Additionally, it may facilitate both initial fitting and subsequent adjustments of hearing aids outside of clinical settings.

Objective. Electrical neuromodulation is an established non-pharmacological treatment for chronic pain. However, existing devices using pulsatile stimulation typically inhibit pain pathways indirectly and are not suitable for all types of chronic pain. Direct current (DC) stimulation is a recently developed technology which affects small-diameter fibres more strongly than pulsatile stimulation. Since nociceptors are predominantly small-diameter Aδ and C fibres, we investigated if this property could be applied to preferentially reduce nociceptive signalling. Approach. We applied a DC waveform to the sciatic nerve in rats of both sexes and recorded multi-unit spinal activity evoked at the hindpaw using various natural stimuli corresponding to different sensory modalities rather than broad-spectrum electrical stimulus. To determine if DC neuromodulation is effective across different types of chronic pain, tests were performed in models of neuropathic and inflammatory pain. Main results. We found that in both pain models tested, DC application reduced responses evoked by noxious stimuli, as well as tactile-evoked responses which we suggest may be involved in allodynia. Different spinal activity of different modalities were reduced in naïve animals compared to the pain models, indicating that physiological changes such as those mediated by disease states could play a larger role than previously thought in determining neuromodulation outcomes. Significance. Our findings support the continued development of DC neuromodulation as a method for reduction of nociceptive signalling, and suggests that it may be effective at treating a broader range of aberrant pain conditions than existing devices.

Objective. In recent years, EEG-based Brain-Computer Interfaces (BCIs) applied to inner speech classification have gathered&#xD;attention for their potential to provide a communication channel for individuals with speech disabilities. However, existing methodologies for this task fall short in achieving acceptable accuracy for real-life implementation. This paper concentrated on exploring&#xD;the possibility of using inter-trial coherence (ITC) as a feature extraction technique to enhance inner speech classification accuracy&#xD;in EEG-based BCIs. Approach. To address the objective, this work presents a novel methodology that employs ITC for feature&#xD;extraction within a complex Morlet time-frequency representation. The study involves a dataset comprising EEG recordings of&#xD;four different words for ten subjects, with three recording sessions per subject. The extracted features are then classified using&#xD;k-Nearest-Neighbors (kNN) and Support Vector Machine (SVM). Main results. The average classification accuracy achieved using&#xD;the proposed methodology is 56.08% for kNN and 59.55% for SVM. These results demonstrate comparable or superior performance in comparison to previous works. The exploration of inter-trial phase coherence as a feature extraction technique proves&#xD;promising for enhancing accuracy in inner speech classification within EEG-based BCIs. Significance. This study contributes to&#xD;the advancement of EEG-based BCIs for inner speech classification by introducing a feature extraction methodology using ITC.&#xD;The obtained results, on par or superior to previous works, highlight the potential significance of this approach in improving the&#xD;accuracy of BCI systems. The exploration of this technique lays the groundwork for further research toward inner speech decoding.

Objective. Chronic motor impairments of arms and hands as the consequence of a cervical spinal cord injury (SCI) have a tremendous impact on activities of daily life. A considerable number of people however retain minimal voluntary motor control in the paralyzed parts of the upper limbs that are measurable by electromyography (EMG) and inertial measurement units (IMUs). An integration into human-machine interfaces (HMIs) holds promise for reliable grasp intent detection and intuitive assistive device control. Approach. We used a multimodal HMI incorporating EMG and IMU data to decode reach-and-grasp movements of groups of persons with cervical SCI (n = 4) and without (control, n = 13). A post-hoc evaluation of control group data aimed to identify optimal parameters for online, co-adaptive closed-loop HMI sessions with persons with cervical SCI. We compared the performance of real-time, Random Forest-based movement versus rest (2 classes) and grasp type predictors (3 classes) with respect to their co-adaptation and evaluated the underlying feature importance maps. Main results. Our multimodal approach enabled grasp decoding significantly better than EMG or IMU data alone (p $\lt$ 0.05). We found the 0.25 s directly prior to the first touch of an object to hold the most discriminative information. Our HMIs correctly predicted 79.3 ± STD 7.4 (102.7 ± STD 2.3 control group) out of 105 trials with grand average movement vs. rest prediction accuracies above 99.64% (100% sensitivity) and grasp prediction accuracies of 75.39 ± STD 13.77% (97.66 ± STD 5.48% control group). Co-adaption led to higher prediction accuracies with time, and we could identify adaptions in feature importances unique to each participant with cervical SCI. Significance. Our findings foster the development of multimodal and adaptive HMIs to allow persons with cervical SCI the intuitive control of assistive devices to improve personal independence.