A 4-DOF Exosuit Using a Hybrid EEG-Based Control Approach for Upper-Limb Rehabilitation.

Rehabilitation devices, such as traditional rigid exoskeletons or exosuits, have been widely used to rehabilitate upper limb function post-stroke. In this paper, we have developed an exosuit with four degrees of freedom to enable users to involve more joints in the rehabilitation process. Additionally, a hybrid electroencephalogram-based (EEG-based) control approach has been developed to promote active user engagement and provide more control commands.The hybrid EEG-based control approach includes steady-state visual evoked potential (SSVEP) paradigm and motor imagery (MI) paradigm. Firstly, the rehabilitation movement was selected by SSVEP paradigm, and the multivariate variational mode decomposition (MVMD) and canonical correlation analysis (CCA) method was used for SSVEP EEG recognition; then, the motion intention was obtained by MI paradigm, and the convolutional neural network (CNN) and long short-term memory network (LSTM) were used to build a CNN-LSTM model for MI EEG recognition; finally, the recognition results were translated into control commands of Bowden cables to achieve multi-degree-of-freedom rehabilitation.Experimental results show that the average classification accuracy of the CNN-LSTM model reaches to 90.07% ± 2.23%, and the overall accuracy of the hybrid EEG-based control approach reaches to 85.26% ± 1.95%. The twelve subjects involved in the usability assessment demonstrated an average system usability scale (SUS) score of 81.25 ± 5.82. Additionally, four participants who underwent a 35-day rehabilitation training demonstrated an average 10.33% increase in range of motion (ROM) across 4 joints, along with a 11.35% increase in the average electromyography (EMG) amplitude of the primary muscle involved.The exosuit demonstrates good accuracy in control, exhibits favorable usability, and shows certain efficacy in multi-joint rehabilitation. Our study has taken into account the neuroplastic principles, aiming to achieve active user engagement while introducing additional degrees of freedom, offering novel ideas and methods for potential brain-computer interface (BCI)-based rehabilitation strategies and hardware development.Clinical impact: Our study presents an exosuit with four degrees of freedom for stroke rehabilitation, enabling multi-joint movement and improved motor recovery. The hybrid EEG-based control approach enhances active user engagement, offering a promising strategy for more effective and user-driven rehabilitation, potentially improving clinical outcomes.Clinical and Translational Impact Statement: By developing an exosuit and a hybrid EEG-based control approach, this study enhances stroke rehabilitation through better user engagement and multi-joint capabilities. These innovations consider neuroplasticity principles, integrating rehabilitation theory with rehabilitation device.