7.1.1 NeuroPrehens

• Keywords:
  Python, Qt, GUI (Graphical User Interface), Medical, Medical applications, Real-time application
• Functional Description:
  Python application using a framework of input as EMG, IMU, Foot switchs, Camera etc. for controlling a Functional Electrical Stimulation neuroprosthesis in real time closed loop for prehension restoration in hemiplegic stroke patients.
• Contact:
  Christine Azevedo Coste
• Participants:
  David Gasq, Ronan Le Guillou, Christine Azevedo Coste
• Partner:
  CHU de Toulouse

7.1.2 IMUSEF

• Keywords:
  Inertial module unit, Movement analysis, Software platform, Embedded systems
• Scientific Description:
  Modular embedded framework for real-time control of Functional Electrical Stimulation in closed loop with sensor feedback.
• Functional Description:
  IMUSEF allows to acquire data from inertial sensors in order to estimate a segment orientation or a joint angle. From this, an event can be defined to be used to control an electrical stimulator.
• Release Contributions:
  1.0 : First fully functional version application focused with stimulator control, sensor data acquisition and analysis and decisional algorithm (https://www.mdpi.com/545320). 2.0 : Full rework as a modular framework, allowing selection of decisional algorithm, stimulator system, sensors etc. and optional communication and control in real time from a remote fully featured Graphical User Interface through autonomous hotspot wifi.
• News of the Year:
  New major version (2.0).
• URL:
  https://­gitlab.­inria.­fr/­CAMIN/­imusef/­imusef_app
• Publication:
  lirmm-02305548, version 1
• Contact:
  Christine Azevedo Coste
• Participants:
  Benoît Sijobert, Ronan Le Guillou, Christine Azevedo Coste, Martin Schmoll
• Partner:
  Université de Montpellier 2

7.1.3 ID-IMU

• Name:
  Intention Decoder based on IMU
• Keywords:
  Inertial module unit, Classification, Movement analysis, Recognition of human movement, Artificial intelligence
• Scientific Description:
  The software process IMU data (accelerometer and gyroscope, 3 axes each) by differentiating it at each new data point, and band-pass filtering it. Then, in a moving window fashion, it extract the following features: rms (root mean square), average, and psd (power spectrum density). Finally, it uses these features as input for training or classifying detected movements. Movements are detected based on a threshold applied to the resultant movement data in the window. The classifier is a nu-SVM (nu-support vector machine) with linear kernel. Most parameters are editable in the parameters.json file.
• Functional Description:
  Users can wear movement sensors (IMUs) on different parts of their bodies and train the system to identify specific and arbitrary movements. These can then be used to activate or trigger other devices, such as neuroprostheses, or robots. As is, this software can read and classify movement data stored in files according to the AGILIS standards by the time of its publication. The real time reading of sensor data and device actuation is out of scope.
• Release Contributions:
  This versions adds a feature for saving data at intermediate steps, in addition to the final classification results.
• URL:
  https://­gitlab.­inria.­fr/­luolivei/­movementclassification-cpp
• Contact:
  Christine Azevedo Coste
• Participants:
  Lucas Oliveira Da Fonseca, Christine Azevedo Coste

7.1.4 ANT4ROTOR

• Name:
  ANT+ communication for Rotor 2INPOWER
• Keywords:
  Motion analysis, Communicating devices, Power monitoring, Monitoring
• Functional Description:
  Based on the ANT+ communication protocol's Python library, this project unlocks the low frequency limits (4Hz) from the default ANT+ protocol to allow acquisition of the ROTOR "Fast Mode" data streaming (50Hz) through ANT+. This enables data acquisition and monitoring of crank angle, cadence, average power, torque applied on the left and right side independently and more, at frequencies sufficient to analyse the pedalling dynamics inside of a turn rather than having a simple overview of it.
• Release Contributions:
  Version 1 : Complete and functional project. Tested on ROTOR 2INPOWER only, with a RPI 3B.
• URL:
  https://­gitlab.­inria.­fr/­CAMIN/­ant4rotor
• Contact:
  Christine Azevedo Coste
• Participants:
  Martin Schmoll, Ronan Le Guillou, Christine Azevedo Coste

7.2.1 Exofinger: an orthotic solution to restore key-grip function in a user with tetraplegia

Participants: Marie Ghekiere, Clément Trotobas, Christine Azevedo, Benoît Sijobert, Christophe Braillon [SED Grenoble], Roger Pissard-Gibollet [SED Grenoble], Laurence Boissieux [SED Grenoble].

In 2020, we participated to the Fabrikarium 2020 organized by My Human Kit1 and Ariane Group. A Fabrikarium is a 3-day prototyping workshop dedicated to disabilities that brings together 9 people around a project holder with a disability2. The EXOFINGER project aimed at developping a hand orthosis for the project holder: a user with complete C6 tetraplegia who expressed the need to grasp objects in key grip.

During the event, two prototypes were produced. Both were cable driven and worked on the same principle: when a button is activated, the control unit triggers the linear motor. The linear motor pulls or releases a cable connected to the thumb, closing the grasp. One of the prototypes was made of a custom made textile glove; the cable passes through a sheath and then through sleeves on the glove. For this, a DC motor coupled with a V-coil placed on the forearm of the user wind a nylon cable attached to his thumb (fig. 3). This causes a tension on his thumb which closes on his index finger.

We have continued to improve the Exofinger orthosis within the Exploratory Action HumanLab Inria3.

The improvements made are mainly mechanical to increase the thumb-tightening stroke and make the prototype more usable on a day-to-day basis (wireless button module, Android App...(fig. 4)).

Moreover, an experimental protocol for the validation of the functional characteristics of the Exofinger orthosis has been developed and submitted to Coerle. We expect to identify the potential users of such a solution and validate the preliminary design.

7.2.2 Monitoring tremor in ecological conditions : PARaKeet

Participants: Ronan Le Guillou, Christine Azevedo, Christian Geny [CHU Montpellier, France], Gregory Baptista [Montpellier Mindfulness Centre, France].

As part of a preliminary study on the effects of Mindfulness meditation on participants with Parkinson’s Disease (PD) (10.3 Partnerships and Cooperations : National Initiatives : LABEX NUMEV - MEDITAPARK ), an application was developed to monitor at home tremor occurrence using a smartwatch Samsung Gear S3 and its newer model, the Samsung Galaxy Watch (fig.5). A Python program has been developed to process and format the recorded data, extract specific features and present the characteristics of the Parkinson tremors under a user friendly and comprehensible format for clinicians. This was finalized this year through a comprehensive rewriting where precision and accuracy of data processing was improved. Furthermore, the ease of use of the automatized data processing and the automatic generation of reports on the patient's detected tremors were completed and improved upon, compared to the previous versions. The goal of this system being to identify Parkinson’s tremors characteristics qualitatively and quantitatively to highlight global tendencies and help objectively determine effectiveness of diverse treatments against PD tremors. This system was tested again and validated through visual confirmation using acquired tremor data coupled to videos of the watch on a volunteering participant. The different levels of tremor severity were calibrated through data/video comparison with the clinical assessment provided by Dr. Christian Geny.

A one day sample of acquisition is presented in a hourly format displaying the evaluation of the quantity of displacement generated by parkinson tremors during each hour as well as the average severity estimation of the related tremors (fig.6). The created system allows the qualification of tremors in punctual clinical check-ups in the Hospital as well as quantitative formatting of daily tendencies. This system should now allow to highlight the evolution of several characteristics from Parkinson’s tremors throughout the MBSR (Mind-fullness Based Stress Reduction) meditation program which has now started in November 2021. This clinical protocol aims to evaluate the impact of Mind-fulness Based Stress Reduction on PD tremors. Acquisition of the data pre-MBSR program was concluded successfully for the first session of the protocol. The ClinicalTrial.gov ID of this protocol is : NCT05168046. The software APP of this platform can be found here as the PARa-Keet Project with the Bil Id: Software_3565.

8.1.1 A method based on wavelets to analyze overlapped and dependant M-Waves

Participants: Lucie William, Mélissa Dali, Christine Azevedo, David Guiraud.

Implanted multi-contact epineural stimulation could restore hand movement in patients with complete spinal cord injuries. However, assessing the response by surface evoked EMG recordings wass challenging because the forearm muscles are small and overlapping. Moreover, M-waves were dependent because they were induced by a single stimulation paradigm. We hypothesized that the M-waves of each muscle has a specific time-frequency signature (Fig.8) and we have developed a method to reconstruct the muscle recruitment curves using the energy of this specific time-frequency signature. Orthogonal wavelets are used to analyze individual M-waves. As the selection of the wavelet family and the determination of the time-frequency signature were not trivial, the impact of these choices was evaluated. First, we were able to discriminate the 2 relevant M-waves related to the studied muscles thanks to their specific time-frequency representations. Second, the Meyer family, compared to the Daubechies 2 and 4 families, is the most robust choice against the uncertainty of the time-frequency region definition. Finally, the results are consistent with the semi-quantitative evaluation performed with the Medical Research Council (MRC) scoring. The Meyer wavelet transform combined with the definition of a specific area of interest for each individual muscle allows us to quantitatively and objectively evaluate the evoked EMG in a robust manner.

a - Pure thumb

 

b - Pure thumb

 

c - Pure fingers

8.1.2 Influence of the H reflex on the selectivity of recruitment using multi-contact epineural stimulation

Participants: Lucie William, Christine Azevedo, David Guiraud, Charles Fattal.

In AGILIS project during multi-contact epineural stimulation, it was possible to induce involuntary the Hoffman reflex (H-reflex). As the motoneurons have the largest axon diameter, they are usually activated first during the epineural stimulation. However, during the stimulation, it is possible to activated first the axon of sensory Ia afferents because of their large axon diameter. The signal spreads, passes through the spinal cord and activates the $\alpha$-motoneurons which induces the muscle contraction. Taking into consideration this reflex is important in the context of selective stimulation. The H-reflex was observed for one muscle (the pronator teres, resposible for the pronation movement, see Fig.9,a) on the five recorded. The other muscles recorded were the flexor carpi radialis (FCR) responsible for the wrist flexion, the flexor digitorum superficialis (FDS) responsible for the digit (except thumb) flexion, the flexor pollicis longus (FPL) responsible for the thumb flexion and the abductor pollicis brevis (APB) responsible for the thumb abduction. The impact of this phenomenon on the muscle order of recruitment, the recruitment curves (see Fig.9,b and c) and the selectivity was investigated (see Fig.9,d). Thus, taking into consideration the possibility to evoke this reflex is important to have a selective stimulation inducing a functional movement and in our particular case increasing the range of intensity that can be used by possibly blocking it with anodal block.

a- M-wave and H-reflex PT

 

b- Recruitment curve

c- Selectivity

 

d- Recruitment

8.1.3 IMU activation of a neuroprosthesis for individuals with tetraplegia

Participants: Lucas Fonseca, David Guiraud, Arthur Hiairrassary, Charles Fattal, Christine Azevedo.

Assistive technologies may improve autonomy of persons with complete tetralegia but needs for ergonomic interfaces for the user to pilot these device still persist. Despite the paralysis of their arms, people with tetraplegia may retain residual shoulder movements. In this work we explored these movements as a mean to control these devices. We captured shoulder movements with a single inertial sensor and, by training a support vector machine based classifier, we decoded such information into user intent. The setup and training process take only a few minutes and so the classifiers can be user specific. We tested the algorithm with 10 able body and 2 spinal cord injury participants. The average classification accuracy was 80% and 84%, respectively.

The proposed algorithm is easy to set up, its operation is fully automated, and achieved results are on par with state-of-the-art systems. Significance: Assistive devices for persons without hand function present limitations in their user interfaces. Our work present a novel method to overcome some of these limitations by classifying user movement and decoding it into user intent, all with simple setup and training and no need for manual tuning. We demonstrate its feasibility with experiments with end users, including persons with complete tetraplegia without hand function.

This interface was used in AGILIS protocol.

 

8.1.4 EMG activation of a neuroprosthesis for individuals with tetraplegia

Participants: Thekla Stefanou, Lucas Fonseca, David Guiraud, Charles Fattal, Christine Azevedo.

Human-machine interfaces are a crucial part of assistive, prosthesis and rehabilitation devices. It is essential to correctly identify the user's intent or orders to properly control such devices. We are specifically focusing on the activation of an upper-limb neuroprosthesis developed for individuals with complete tetraplegia (lesions at C4-C6) as in AGILIS protocol using surface electromyography signals (sEMG). We seek to understand, decode and classify surface electromyography (sEMG) signals in order to distinguish between the movements that may be used to activate a neuroprosthesis (AGILIS project) and other every day actions that involve the activation of similar muscles.

Primary experiments: frequency-domain sEMG analysis and classification results

We analysed surface electromyography (sEMG) signals of the trapezius and platysma muscles, that will be used to activate the neuroprosthesis, in ten able-bodied participants (Protocol A) and two participants with tetraplegia (Protocol B / Agilis protocol). Turning cross-talk to our advantage we demonstrated how one can recognise multiple motions or muscle contractions using a single sEMG channel. Protocol A involved the performance of shoulder raise (SR), shoulder forward (SF), shoulder backward (SB), shoulder raise-and-hold (SRH) and object raise (OR). In Protocol B individuals with tetraplegia performed shoulder raise and platysma contraction.

Figure 11 demonstrates the sEMG signal processing and feature extraction. Parametric algorithms were used to classify these features. This included decision trees (when a large amount of data were available) and applying thresholding on the features using the median values. Some interesting findings included:

• a muscle's activity has a specific frequency signature depending on the movements performed
• as a result of cross-talk, classification of SF and SB is also feasible using the trapezius sensor data despite having different agonists,
• the sEMG sensor placed on the platysma muscle contains information on both platysma muscle contraction and shoulder raise.

We attempt to promote a more optimal use of sEMG signal to better fit a future "home use" system. Single-channel sEMG control could simplify a system or provide contingencies in more complex systems.

8.2.1 User requirements for upper limb hybrid neuroprosthesis

Participants: Fernanda Ferreira, Lucas Fonseca, Christine Azevedo, Clément Trotobas, Ronan Le Guillou, Charles Fattal, David Gasq [CHU Toulouse, France], Claysson Vimieiro [UFMG, Brazil], Adriana Valladao [UFMG, Brazil].

A multicenter pilot study is being conducted in different countries, mainly France and Brazil, on health care professionals and people with neurological disorders. An online questionnaire has been developed by Inria, which included a risk analysis with the data privacy organization of INRIA. The objective is to investigate the essential requirements (needs, preferences, and expectations) of potential users that need to be met during the development of upper limb hybrid neuroprosthesis. This will promote a higher level of compliance, acceptance, and satisfaction with the use of the device, as well as to minimize user abandonment.

The questionnaire was developed with the contribution of 9 professionals from a clinical and engineering multidisciplinary research team composed of medical doctors in physical medicine, occupational therapists and engineers from Brazil and France (USSAP Perpignan and CHU Toulouse). As a pre-test, a small pilot study was conducted on 10 participants (5 in Brazil and 5 in France) in order to ensure relevance and validate the questions, to check that the questions are clear and easily understandable. The questionnaire is currently being widely disseminated on a secure platform at Inria that can be found online.

To our knowledge, this is the first study that investigates user needs for the development of upper limb hybrid neuroprosthesis.

8.2.2 Hybrid neuroprosthesis for rehabiliation in post-stroke hemiplegia

Participants: Fernanda Ferreira, Lucas Fonseca, Christine Azevedo, Claysson Vimieiro [UFMG Brazil], Adriana Valladao [UFMG Brazil].

A portable robotic exoskeleton for upper limb rehabilitation of post-stroke individuals, called Pinotti Portable Robotic Exoskeleton (PPRE) was developed at the Bioengineering Laboratory (Labbio) at the Federal University of Minas Gerais (UFMG). It was improved by adding Functional Electrical Stimulation (FES), transforming it into a hybrid robotic exoskeleton. Fernanda Rodrigues spend 1 year in CAMIN team while she was a UFMG PhD student to work on this topic.

The PPRE was segmented into two functional modules: hand and elbow. The elbow module is responsible for flexing and extending the elbow and the hand module is responsible for extension of the second to fifth fingers. Both are motor-driven from Maxon Motors™. To improve the device, modifications were made to the hand module by removing the motor and mechanical structures and adding FES, transforming it into a Hybrid FES-Robotic Orthosis. A computer program was developed using Python to integrate the different drive systems (motor and FES), and a new graphic interface was created to facilitate the operation by users. Thus, it was possible to increase the number of movements provided by the equipment from one (extension of the 2nd to the 5th finger) to five (extension and flexion of the 2nd to the 5th finger, thumb extension, adduction and abduction with thumb opposition), enabling the execution of other types of grasps and amplifying the repertoire of possible activities. In addition, the mechanical structure was simplified, the volume decreased, the total weight was reduced and, consequently, greater portability was achieved. Furthermore, it enables direct activation of the paretic muscles, thus reducing the user's passive posture and favoring increased motor control, which should promote functional recovery.

The equipment was tested through experimental tests and it was observed that the system proved to be effective in performing tasks of reaching and grasping different objects with the combination of movements of the elbow and hand modules, indicating that it can be used to perform functional activities. Furthermore, the correct functioning of the system was verified in 2 healthy participants, stimulating with efficiency the desired muscles. In the future, tests will be carried out on individuals with upper limb motor impairment as a result of stroke to ratify these results. This project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CAAE Registry: 22207213.5.0000.5149).

8.2.3 Systematic review on upper limb hybrid neuroprostheses for rehabilitation of neurological disorders

Participants: Fernanda Ferreira, Lucas Fonseca, Christine Azevedo, Claysson Vimieiro [UFMG Brazil], Adriana Valladao [UFMG Brazil].

Previous studies indicate that hybrid systems may be more effective in improving motor control and functional skills compared to robotic therapy alone in patients with hemiparesis after chronic stroke and compared to traditional physical therapy in individuals with acute stroke. However, although studies prove the potential benefit of this technology, few randomized controlled trials have been conducted so far and no systematic literature review has been carried out. Systematic reviews are necessary because it is the most appropriate and current method for summarizing and synthesizing evidences about the effectiveness and effects of interventions. Therefore, this project is investigating systematically the effects of HRRS on central injuries upper limb recovery based on each of the International Classification of Functioning, Disability and Health (ICF) domains. This study will contribute to the development of new hybrid neuroprostheses that are proven to be effective for upper limb rehabilitation. This systematic review is currently underway with the participation of physicians, occupational therapists and engineers. It is registered in PROSPERO under protocol CRD42021227548 23. 

8.2.4 Orthyb: an assistive hybrid orthosis for upper limb function

Participants: Clément Trotobas, Christine Azevedo, Fernanda Rodrigues Ferreira Lopes, Andrew Murray [DimLab Dayton], Roger Pissard-Gibollet [SED Grenoble].

The goal of this project is to give functional mobility to paralyzed hand and wrist of people in order to hold an object in palmar grasp. The context is not rehabilitation as in PPRE device but an assistive solution for daily tasks execution. The challenge is to explore novel technologies to propose a light and modular solution. The device to be developed is a hybrid orthosis composed of a mechanical orthosis and a stimulator. The wrist and finger movements will be generated by muscle contractions through functional electrical stimulation (FES) while the guiding and locking are mechanical. This locking would make it possible to limit early muscle fatigue while maintaining the grip.

A first mechanical orthosis was developed by the startup Aufratech based on CAMIN team specifications in order to assess the general principles of the approach. It includes two DC motors, one for extension and flexion of the wrist, and one for all fingers (fig. 15). It is a cable driven orthosis meaning that motors pull or release cables, moving the limbs. Although the mechanical orthosis is already developed, it lacks drivers and control unit. To date, the driver used is a L298N and the control board is a Adafruit feather nRF52840 express. Moreover, cited participants are the first to test over several months this orthosis and some modifications could be planned. The orthosis can be controlled via keyboard inputs; it is possible to set and move the orthosis to wanted positions and move by increments.

The electrical stimulator chosen is the Vivaltis Phoenix for its portability. Application Programming Interfaces (APIs) have already been developed in Matlab, C++ and Python. Even if an updated of the API is necessary, the Python version has been chosen for the ease of developing an Graphical User Interface (GUI).

The GUI is currently being developed. It includes both orthosis and stimulator setup and control (fig. 16).

To validate experimentally the approach, a protocol will be carried at the Federal University of Minas Gerais (UFMG) in Brazil. A protocol has been edited and proposed to the local Ethics Committee.

 

8.2.5 Modular Elbow-Forearm Orthosis

Participants: Clément Trotobas, Christine Azevedo, Andrew Murray [DimLab Dayton], Marie Ghekiere.

The goal of this project is to imagine novel light and wearable orthotic solutions for upper-limb movements assistance. The objective is to give functional mobility of paralyzed elbow and forearm. The device to be developed would be an hybrid orthosis composed of a mechanical orthosis and a stimulator. The elbow and forearm movements will be generated by muscle contractions through functional electrical stimulation (FES) while the guiding and locking are mechanical. This locking would make it possible to limit early muscle fatigue while maintaining a position.

Disability can be very different from an individual to another and the approach of one size fits most is questionable. Thus, the orthosis is intended to be modular with both pods from Vivaltis Phoenix stimulator (fig. 15) and mechanical modules close to the one developed for Exofinger (fig. 17). It would include control board with bluetooth low energy (BLE), batteries, DC motors coupled with coils to wind cables to move limbs. These modules, including Vivaltis pods, could be placed on straps enabling a position and a number fitting the wearer's needs.

 

8.4.1 SCS for rehabilitation of bladder, bowel and sexual functions in spinal cord injury – SPINSTIM Project

Spinal cord injuries have disastrous consequences for individuals, who, in addition to the motor impairments, must deal with sexual, bowel and urinary problems. Beyond their impact on health, these disorders have psychosocial implications that must not be neglected. Regarding lower urinary tract (LUT) function, SCI induces a communication breakdown between supraspinal and spinal levels that not only manifests by the loss of voluntary control of micturition but also by an exacerbation of reflex processes. Adult neurogenic lower urinary tract dysfunction refers to the urological symptoms associated with these disturbances and expresses clinically by two major problems: the disruption of the detrusor activity (detrusor overactivity – DO or detrusor underactivity – DU) and the detrusor sphincter dyssynergia (DSD).

Systematic review on Sacral Anterior Root Stimulation (SARS)

Participants: Thomas Guiho, Luc Bauchet [CHU Montpellier, France], Jean-Rodolphe Vignes [CHU Bordeaux, France], Claire Delecci [CHU Bordeaux, France], Christine Azevedo Coste, Charles Fattal, David Guiraud.

In order to restore urinary function, a device based on a strategy of functional electrical stimulation – more specifically, sacral anterior root stimulation (SARS) – was developed 40 years ago: the Brindley-Finetech® implant (or SARS implant). However, the Brindley device does not handle DO by itself as bladder contractions at low filling are still likely induced by the disturbed sacral reflex arch. Sacral deafferentation (i.e., sectioning of the sacral posterior roots, procedure called rhizotomy) is often coupled with SARS implantation to prevent DO – and, consequently, promote bladder compliance – but results in the potentially irreversible loss of spared perineal sensation and function (erection and ejaculation in men, vaginal lubrication in women, defecation). In an article published in World Neurosurgery in September 14, we systematically reviewed (Preferred Reporting Items for Systematic reviews and Meta-Analyses – PRISMA – recommendations) the reports of 40 years of SARS implantation and assessed the medical added-value and limits of this approach through four axes of investigation: i) impact on visceral functions, ii) implantation safety and device reliability, iii) individuals quality of life, and iv) additional information about the procedure. (fig.21)

Despite generally positive results on visceral functions – especially LUT function – the number of Brindley implantation procedures has declined in recent years. Thus, the rehabilitation of visceral functions remains a major concern of individuals with SCI, and we decided to investigate less invasive solutions or alternatives that are likely to offer these persons a dramatic gain in quality of life.

Pig experiment campaign

Participants: Thomas Guiho, Jean-Luc Boulland [Oslo University], Christine Azevedo Coste, David Guiraud.

This work aimed at investigating various techniques for spinal cord electrical stimulation in order to address dysfunctions in spinal cord injured individuals on lesion levels that have an impact on lower limb movements and bladder, bowel and sexual functions. Orderly recruitment of fibers at the spinal cord level should eventually lead to orderly recruitment of the detrusor muscle without activation of the bladder sphincter. Thereby, low pressure voiding, for example, should be obtained but is currently impossible with existing active implantable medical devices. Two experimental explorations were performed with direct spinal cord stimulation in Oslo in December (on 2 pigs). Experiments were conducted in collaboration with the University of Oslo and additional experiments are expected in the next few months subject to an improvement of the covid-19 situation. Data will be further processed in the next few months after recruitment of a master student. (fig.22)

8.4.2 Investigation of cervical spinal cord stimulation (SCS) on upper limb functions in rhesus macaques

Participants: Thomas Guiho, Andrew Jackson [Newcastle University].

From January to February 2021, Thomas Guiho was seconded in Newcastle University to investigate the impact of spinal cord stimulation protocols at a cervical level on upper limb functions in rhesus macaques. Both stimulation during sedated and awake sessions were implemented in intact animals while phamacological inactivation of upper limbs was performed to mimic impairments following spinal cord injury. A novel multielectrode cuff was placed around both and ventral surface and multiple stimulation parameters were further investigated in an attempt to highlight the mechanism of action of SCS.

8.6.1 Post Stroke upper limb rehabilitation with tangible BCI : GRASP-IT

Participants: Ronan Le Guillou, Christine Azevedo, David Gasq [CHU Toulouse, France], Laurent Bougrain [LORIA, France].

Stroke is a major cause of disability in adults. The GRASP-IT project aims at improving the motor recovery of the upper limb of post-stroke hemiplegic patients by designing and using a gamified system that integrates complementary stimulation modalities (functional electrical, haptic and tangible stimulation) in brain-computer interfaces (BCIs) based on the generation of kinesthetic motor imaginations (KMI) (fig.24).

This project, carried by Laurent Bougrain [LORIA], proposes to design and evaluate the usability (including the effectiveness of the interactions with respect to the stimulation of the motor and somatosensory cortex) and the acceptability of the interface, called GRASP-IT, and of the interactions it induces. This project integrates both the design of the solutions and their evaluation, through an ambitious clinical evaluation including 75 patients in 3 functional rehabilitation centers in France. The GRASP-IT project is planned over 48 months to allow the design and validation of evaluation methods (preliminary and final) within a multicenter clinical protocol.

As collaborators in this project, and one of the clinical centers [CHU Toulouse], in preparation for the clinical experiments to start (expected to be Q3-Q4 2022), we developped a module allowing Functional Electrical Stimulation as a feedback modality for the Grasp-IT project.

8.6.2 Post Stroke upper limb neuroprosthesis : Projects Prehen-Stroke & Grasp-Again

Participants: Ronan Le Guillou, Christine Azevedo, David Gasq [CHU Toulouse].

The improvement of the grasp abilities remains a challenge in 50% of post-stroke subjects who have not recovered functional grasping due to paralysis of the finger’s extensor muscles. Following the ePrehension-Stroke study in 2019-2020 and its informative results, a new study was started. The PHRCi Prehen-Stroke project (ClinicalTrials.gov Identifier: NCT04804384), aims to evaluate the piloting modalities and the functional impact of a grasping neuroprosthesis in the vascular hemiparetic patient. The addition of new features like voice control was completed and inclusions of participants have begun (fig.25). An embedded version of this grasping neuroprosthesis is being developped to further evaluate its functional impact on the grapsing abilities of hemiplegic patients at home. This embedded version is to be used as part of an ancillary study of Prehen-Stroke, named Grasp-Again, which is being written currently.

10.1.1 Inria associate team not involved in an IIL or an international program

10.1.2 Participation in other International Programs

10.2.1 Visits of international scientists

10.2.2 Visits to international teams

11.1.1 Scientific events: organisation

11.1.2 Scientific events: selection

11.1.3 Journal

11.1.4 Invited talks

• Thomas Guiho presented his work at the 10th NUMEV scientific days. Talk entitled: “Spinal cord stimulation to restore functions in people with spinal cord injury – a highly multidisciplinary challenge”
• Christine Azevedo and Charles Fattal presented AGILIS project at the Cyber Days in Lyon. Talk entitled: “Restoring functional grasping in individuals with complete tetraplegia using neural stimulation.” https://­lyon-cyber-days.­sciencesconf.­org/
• David Guiraud presented AGILIS project within livestorm INRIA coferences.

11.1.5 Leadership within the scientific community

Christine Azevedo is member of IFESS society board.

11.1.6 Scientific expertise

• Christine Azevedo reviewed a Research project for Natural Sciences and Engineering Research Council of Canada (NSERC) - Discovery Grant proposal.
• Christine Azevedo was expert for the French call for proposals "Appel à Projet RIN RECHERCHE EMERGENTS 2021."
• David Guiraud was reviewer of the ANR-FNS (Switzerland) common call in 2021.

11.1.7 Research administration

• Christine Azevedo is a member of COERLE (Inria Commité d'éthique)
• Christine Azevedo is a member of NICE committee, a subgroup of Sophia teamp projects committee (CEP) 7
• Christine Azevedo participated into the Selection committee of a Professor at ENS de Lyon (April 2021)
• Christine Azevedo participated into the INRIA Selection committee Recruitment campaign for Reserachers with disabilities
• Thomas Guiho is responsible for the “Neuroprostheses” teaching unit. This unit is an option common to all the masters of the ICT for health training package.

11.2.1 Teaching

• Master biology and health: Christine Azevedo, Thomas Guiho, David Guiraud, “Bionic approaches: Electrical stimulation in rehabilitation, sensory feedback restoration and BCI” 4.5h, M2, Montpellier University, France
• Master ICT for Health, Neuroprostheses option: François Bailly, “Biomechanics”, 3h, M2, Montpellier University, France
• Master ICT for Health, Neuroprostheses option: Thomas Guiho, “Neuroanatomy”, 3h, M2, Montpellier University, France
• Master ICT for Health, Neuroprotheses option: Ronan Le Guillou, “Control basics and signal processing”, 9h, M2, Montpellier University, France
• Master ICT for Health, Neuroprotheses option: Olivier Rossel, “Signal processing and experimental set-up”, 4.5h, M2, Montpellier University, France
• Master ICT for Health, Neuroprotheses option: Felix Schlosser-Perrin, “Electrophysiological mapping during awake brain surgery”, 3h, M2, Montpellier University, France
• Master ICT for Health, Neuroprotheses option: Lucie William, “Spontaneous and evoked muscle activity”, 3h, M2, Montpellier, France
• Master Sciences & Numérique pour la Santé (SNS), "Structure et Problématique de Santé" option: Lucie William, "The neuron in its environment", 1.5h, Montpellier University, France.
• David Guiraud was invited to the winter school organized by CNRS on "Interfaces"

11.2.2 Supervision

• PhD in progress : Lucie William, "Selective implanted neural stimulation to recover the prehension for quadriplegic", University of Montpellier-Inria-NEURINNOV, october 2019-March 2023, supervised by David Guiraud and Christine Azevedo
• PhD in progress : Hélène Moron, MD, "Jitter of MUAP measured through needle EMG used as a biomearker of the Botulin toxin effect", University of Montpellier-Inria, october 2019-september 2022, supervised by David Guiraud and Arnaud Dupeyron.
• PhD in progress : Clément Trotobas, "Design of arm assistive technologies", University of Montpellier-Inria-Dayton University, september 2020-september 2023, supervised by Christine Azevedo and Andrew Murray (Dayton Univ)
• PhD in progress : Ronan Le Guillou, "Design of a wearable neuroprosthetic solution for arm rehabilitation in post-stroke hemiplegia", University of Montpellier-Inria-CHU Toulouse, December 2020-December 2023, supervised by Christine Azevedo and David Gasq (CHU Toulouse)
• PhD in progress : Félix Schlosser-Perrin, " Modélisation des effets électrophysiologiques de la stimulation électrique sur le cerveau et preuves expérimentales en chirurgie des tumeurs cérébrales : variation de l’intensité, de la distance inter-électrode et la largeur du pulse de stimulation", University of Montpellier, september 2021-september 2024, supervised by François BonnetBlanc and Emmanuel Mandonnet (PU-PH en Neurochirurgie à l'APHP)

11.2.3 Juries

• Christine Azevedo participated in Fernanda Rodrigues (University Federal of Minas Gerais, Brazil) PhD defense, September 30th: "HYBRID ROBOTIC SYSTEM FOR REABILITATION OF THE TOP MEMBER OF POST-STEPHALIC VASCULAR STroke INDIVIDUALS: User-Centered Design.3
• Christine Azevedo participated in Tiago Coelho (University Federal of Minas Gerais, Brazil) PhD Qualification defense, November 25th: "Development and application of a high-capacity Functional Electrical Stimulation system for assisted cycling and the impact of different training programs on the physical conditioning of a subject with paraplegia."

11.3.1 Internal or external Inria responsibilities

Christine Azevedo and Roger Pissard-Gibollet (SED Grenoble) coordinate the HumanLab Inria action https://­project.­inria.­fr/­humanlabinria/.

11.3.2 Articles and contents

Christine Azevedo Portrait in A.N.T.S association https://­ants-asso.­com/­vie-asso/­portrait/­christine-azevedo-coste/

11.3.3 Education

• Christine Azevedo gives sessions of programming initiation with Thymio Robot in a middle school class (Collège Léon Cordas, Montpellier) (8 hours)
• Christine Azevedo presented the job of researcher at Lycée Joliot Curie High School (Sète) during a day dedicated to women en engineering position (6 hours).

11.3.4 Interventions

• Lucie William participated into "Ma thèse en 180s" event and was finalist at the regional level.
• Christine Azevedo and Roger Pissard-Gibollet (SED Grenoble) presented the HumanLab Inria action (September 14) to all members of the institute during a videoconference.

International journals

• 11 articleA.Anthony Boyer, S.Sofiane Ramdani, H.Hugues Duffau, M.Mélissa Dali, M.Marion Vincent, E.Emmanuel Mandonnet, D.David Guiraud and F.François Bonnetblanc. Electrophysiological Mapping During Brain Tumor Surgery: Recording Cortical Potentials Evoked Locally, Subcortically and Remotely by Electrical Stimulation to Assess the Brain Connectivity On-line.Brain Topography: a Journal of Cerebral Function and Dynamics34January 2021, 221-233
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• 12 article A.Anthony Boyer, C.Chloé Stengel, F.François Bonnetblanc, M.Mélissa Dali, H.Hugues Duffau, F.François Rheault, M.Maxime Descoteaux, D.David Guiraud, A.Antoni Valero-Cabré and E.Emmanuel Mandonnet. Patterns of axono-cortical evoked potentials: an electrophysiological signature unique to each white matter functional site? Acta Neurochirurgica January 2021
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• 13 articleC.Charles Fattal, M.Martin Schmoll, R.Ronan Le Guillou, B.Berengère Raoult, A.Alain Frey, R.Robert Carlier and C.Christine Azevedo-Coste. Benefits of 1-year home training with FES cycling in paraplegia during Covid-19 crisis: case report.American Journal of Physical Medicine and RehabilitationPublish Ahead of PrintSeptember 2021
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• 14 articleT.Thomas Guiho, C.Christine Azevedo-Coste, L.Luc Bauchet, C.Claire Delleci, J.-R.Jean-Rodolphe Vignes, D.David Guiraud and C.Charles Fattal. Sacral Anterior Root Stimulation (SARS) and Visceral Function Outcomes in Spinal Cord Injury–A Systematic Review of the Literature Over Four Decades.World NeurosurgerySeptember 2021
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• 15 articleT.Thomas Guiho, V. M.Victor Manuel López-Álvarez, P.Paul Čvančara, A.Arthur Hiairrassary, D.David Andreu, T.Thomas Stieglitz, X.Xavier Navarro and D.David Guiraud. New Stimulation Device to Drive Multiple Transverse Intrafascicular Electrodes and Achieve Highly Selective and Rich Neural Responses.SensorsOctober 2021
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• 16 articleR.Ronan Le Guillou, M.Martin Schmoll, B.Benoît Sijobert, D.David Lobato Borges, E.Emerson Fachin-Martins, H.Henrique Resende, R.Roger Pissard-Gibollet, C.Charles Fattal and C.Christine Azevedo Coste. A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling.Sensors21132021, 1-13
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• 17 articleX.Xinyue Lu, C.Christine Azevedo Coste, M.-C.Marie-Cécile Nierat, S.Serge Renaux, T.Thomas Similowski and D.David Guiraud. Respiratory Monitoring Based on Tracheal Sounds: Continuous Time-Frequency Processing of the Phonospirogram Combined with Phonocardiogram-Derived Respiration.Sensors211January 2021, 99
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• 18 articleH.Hélène Moron, C.Corine Gagnard-Landra, D.David Guiraud and A.Arnaud Dupeyron. Contribution of Single-Fiber Evaluation on Monitoring Outcomes Following Injection of Botulinum Toxin-A: A Narrative Review of the Literature.Toxins13356May 2021, 16
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• 19 articleS.Sofiane Ramdani, A.Anthony Boyer, S.Stéphane Caron, F.François Bonnetblanc, F.Frederic Bouchara, H.Hugues Duffau and A.Annick Lesne. Parametric recurrence quantification analysis of autoregressive processes for pattern recognition in multichannel electroencephalographic data.Pattern Recognition1092021, #107572
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• 20 articleM.Martin Schmoll, R.Ronan Le Guillou, D.David Lobato Borges, C.Charles Fattal, E.Emerson Fachin-Martins and C.Christine Azevedo Coste. Standardizing fatigue-resistance testing during electrical stimulation of paralysed human quadriceps muscles, a practical approach.Journal of NeuroEngineering and Rehabilitation1811January 2021
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• 21 articleB.Benoît Sijobert, C.Christine Azevedo Coste, J.Joanna Pontier, S.Sahara Graf and C.Charles Fattal. A Sensor-Based Multichannel FES System to Control Knee Joint and Reduce Stance Phase Asymmetry in Post-Stroke Gait.Sensors216March 2021, 2134
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Scientific book chapters

• 22 inbookD.David Guiraud and M.Mélissa Dali. Handbook of NeuroengineeringChapter: Modeling Peripheral Nerve Stimulation.Handbook of NeuroengineeringSpringer SingaporeAugust 2021
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Other scientific publications

• 23 miscF. M.Fernanda Márcia Rodrigues Martins Ferreira, G.Guilherme de Paula Rúbio, L.Lucas Oliveira Fonseca, C.Charles Fattal, A. M.Adriana Maria Valladão Novais Van Petten, C. B.Claysson Bruno Santos Vimieiro and C.Christine Azevedo Coste. Effectiveness of hybrid robotic rehabilitation system on upper limb recovery of people with central injuries: a systematic review with meta-analysis.January 2021
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