TECHNICAL FIELD

[0001] The present invention generally relates to a neurorehabilitation system for a person with an acquired or developmental neurological condition such as spinal cord injury, brain injury, cerebral palsy, or spasticity. The preferred embodiment of the invention will be presented for application to spinal cord injury (SCI).

BACKGROUND

[0002] The reference to any prior art in this specification is not, and should not be taken as an acknowledgement or any form of suggestion that the prior art forms part of the common general knowledge.

[0003] For thousands of years SCI was thought to be irreversible. This view is now changing. Recent scientific evidence has shown that thought-controlled rehabilitation robots can restore some voluntary movement in SCI. Further evidence suggests that providing motor sensory feedback can restore damaged spinal pathways.

[0004] Other studies have also shown that electrically stimulating spinal cord or muscles can help. Flowever, such stimulation has been known to activate muscles to fracture bones that have been weakened through non-use over time.

[0005] Further studies have shown that rehabilitation using motor-driven

exoskeletons can help regain voluntary movement in SCI. Since the motors, and not the stimulated muscles’ activation, generate the SCI patient’s movement this form of rehabilitation can protect against over loading. Flowever, motor-driven rehabilitation does not facilitate use of stimulated muscle activation and action to generate

movement, as enabled by electrical stimulation.

[0006] Numerous studies have also explored the use of biofeedback in

rehabilitation, using visual, haptic, or auditory monitors to provide information to the user and improve their training. Commonly this involves directly providing visual information regarding joint angles or body position. However, our brain does not directly receive information regarding the position of our joints during movement, instead it

subconsciously interprets the electrical signals from mechanical sensors in our muscles and tendons (i.e. muscle spindles and golgi tendon organs, respectively), which generate electrical signals that are associated with length, velocity and tension of the muscles in which the sensors are embedded.

[0007] The use of all mentioned methods for SCI rehabilitation can be complex and need considerable training. Health professionals are therefore reticent to use these approaches, relying on more time-consuming and less effective hands-on rehabilitation methods.

[0008] The preferred embodiment provides an improved rehabilitation system for rehabilitating a person with a SCI. The preferred system integrates all aforementioned aspects of rehabilitation to help safely regain voluntary movement in SCI. Furthermore, the preferred system, through careful design and use of computer modelling will facilitate the systems ease of use in a clinical setting.

SUMMARY OF THE INVENTION

[0009] According to one aspect of the present invention, there is provided a rehabilitation system for rehabilitating a person with a neurological condition, the system including:

exercise equipment for enabling the person to exercise;

a human machine interface with one or more sensors for sensing information from the person’s head, neck and body during exercise;

a human machine interface that has somatosensory feedback enabled by visual feedback, preferably via virtual/augmented reality, tactile via haptic feedback, or auditory by ear phones;

a personalized computer model of the exercising person on the exercise

equipment configured to receive the information flow from the sensors and generate functional or spinal cord electrical stimulation and motorised assistance, for the person; and

a personalized computer model that is able to synthesize and generate

somatosensory feedback. [00010] According to another aspect of the present invention, there is provided a rehabilitation system for rehabilitating a person with a neurological condition, the system including:

exercise equipment for enabling the person to exercise;

one or more sensors for sensing information from the person during exercise; and a model of the exercising person configured to receive the sensed information from the sensors and generate (functional or spinal cord) electrical stimulation for the person.

[00011] Advantageously, the personalized computer model may be used to generate suitable functional or spinal cord electrical stimulation for the person, and avoid excessive stresses on the person which can lead to the fracturing of bones.

[00012] The personalized computer model may include a neuromusculoskeletal model.

[00013] The sensors may include biomechanical and/or physiological biosensors on the person’s head, neck and/or body. The sensed information may relate to any one or more of electromyography (EMG), inertial measurement units, electroencephalography (EEG), electrooculography (EOG), eye gaze, heart rate, electrocardiography (ECG), and respiration.

[00014] The sensors may include wearable sensors worn by the person.

[00015] The exercise equipment may include a recumbent ergometer, upper-arm ergometer or articulated system, rowing system, or walking system. The system may further include an actuator(s) to assist the person to perform the exercise on the equipment. The actuator may include a motor.

[00016] The sensors may further include one or more equipment sensors for sensing information of the equipment that is also provided to the model for generating the functional or spinal cord electrical stimulation, and/or actuation assistance . The equipment sensors may include speed, motor current, force and/or torque sensors. [00017] The model may be configured to be a human machine interface (HMI) between the person and equipment. The HMI my include a headset, in turn, including an EEG system that will provide data to the brain computer interface (BCI) model to classify the person’s exercise intention and intensity. The intent and intensity may trigger the model to generate functional or spinal cord electrical stimulation and actuation assistance to enable the person to perform the desired exercise on the equipment.

[00018] The model may be further configured to generate sensory data to be feedback to the person via the HMI. The sensory data may include somatosensory, cardiac and/or respiratory data. Sensory data may be provided to person by visual, auditory and/or intact haptic feedback pathways. The HMI headset may provide these extended reality feedback by including virtual or augmented reality, or via ear phones and/or haptic devices.

[00019] According to another aspect of the present invention, there is provided a rehabilitation method for rehabilitating a person with a neurological condition, the method including:

exercising the person with exercise equipment;

sensing information from the exercising person and exercise equipment; and receiving the sensed information and generating functional electrical stimulation and actuator assistance for the person using a model of the exercising person using the exercise equipment.

[00020] Any of the features described herein can be combined in any combination with any one or more of the other features described herein within the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

[00021] Preferred features, embodiments and variations of the invention may be discerned from the following Detailed Description which provides sufficient information for those skilled in the art to perform the invention. The Detailed Description is not to be regarded as limiting the scope of the preceding Summary of the Invention in any way. The Detailed Description will make reference to drawing as follows: [00022] Figure 1 is a schematic view of a rehabilitation system in accordance with an embodiment of the present invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

[00023] According to an embodiment of the present invention, there is provided a rehabilitation system 100 for rehabilitating a person 102 with a SCI. The system 100 includes exercise equipment 104, maybe in the form of a recumbent cycle or ergometer, which enables the person 102 to exercise. Personal wearable head, neck and body biosensors 106 and 107 (biomechanical and physiological biosensors) are provided for sensing personal information 108 and 109 from the person 102 during exercise.

[00024] The system 100 further includes a personalized computer model 1 10 of the exercising person 102 on the exercise equipment 104 for receiving the sensed personal information 108 and 109 from the sensors 106 and 107 and generating electrical stimulation and actuation assistance 1 12 for the person. Advantageously, the

personalized model 1 10 is used in generating suitable adaptive electrical stimulation for the person 102, and avoids excessive musculoskeletal, cardiac and pulmonary stresses on the person 102 as well as the potential fracturing of bones.

[00025] The rehabilitation system 100 further includes equipment sensors (e.g.

speed, torque, etc.) for sensing equipment information 1 14 of the equipment 104. The equipment information 1 14 is also provided to the model 1 10 and used in generating the electrical stimulation and actuation assistance 1 12.

[00026] The model 1 10 is configured to generate sensory data 1 16 to be provided to the person 102 through extended reality feedback 1 18 in the HMI 1 19. The extended reality 1 18 in HMI 1 19 includes a virtual or augmented reality headset 122 with visual 123, auditory 120 and tactile feedback 121 . The HMI 1 19 will employ a brain computer interface (BCI) 124 that may use EEG, EOG, eye gaze sensor data 109 in the headset 122 worn by the person 102. The model 1 10 is also configured to receive data from the BCI 124 that is the interpretation of the person’s required movement when the person 102 thinks about an action. The model 1 10 is typically stored in the cloud 126 and loT enabled. [00027] The functionality of the system 100 is now described in greater detail below.

[00028] The neuromusculoskeletal model 1 10 incorporates a Digital Twin, which is a computer representation of the person's bones, muscles, joints, and nervous system. The Digital Twin technology is used in real-time to virtually bypass the site of SCI, again connecting sensory and motor pathways between brain, spinal cord, and muscles.

[00029] The model 1 10 includes BioSpine, which is an innovative application of Digital Twin technology through the HMI headset 122 that is combined with

virtual/augmented reality 123, auditory 120 and haptic devices 121 , and biosensors 106 and 107. BioSpine integrates a unique set of intelligent rehabilitation assistive technologies controlled by the Digital Twin to restore the interrupted motor and sensory connections in the spine. BioSpine integrates the following discrete technologies into the seamless system 100: HMI 1 19, wearable biosensors 106 and 107, electrical stimulation 1 12 of lower limb muscles of the person 102, motor-assisted leg cycling in the case presented, augmented somatosensory signals 1 16 transformed extended reality 1 18 with visual 123, auditory 120 and haptic 121 biofeedback.

[00030] The system 100 is intuitively and automatically controlled by the personalised Digital Twin of the patient 102.

[00031] Personalised Digital Twins of each participant 102 can be developed combining magnetic resonance imaging (MRI) [2] and artificial intelligence methods.. Electroencephalograms (EEG) can be captured via a portable wireless headset (e.g. Wearable Sensing DSI7 or DSI-VR300, Switzerland) 122 and processed in the BCI 124 using Al methods to discriminate whether the patient wishes to perform, and how intensely they wish to do, in this example case, the cycling exercise.

[00032] In the example case of cycling, the patient’s motor intention to cycle data 124 will control the Digital Twin, which in turn will optimally stimulate muscles via electrical stimulation 1 12 and provide appropriate motorised assistance 1 12 to achieve cycling. Importantly, the Digital Twin coordinates the electrical stimulation 1 12 and motorised assistance 1 12 to ensure that stimulated muscle activation assists, rather than opposes, the motorised actuation to perform the movement. Biomechanical and physiological information 108 from multiple wearable biosensors 106 (e.g., electromyography, inertial measurement units, heart rate, electrocardiogram, and respiration) can be interpreted by the patient’s Digital Twin to progressively adapt the amount of ergometer pedal- assistance in order to maximally engage the patient 102, while also maintaining musculoskeletal tissue loads and cardiovascular demand within safe levels [3, 4]

[00033] Finally, the patient’s Digital Twin can synthesise somatosensory information 1 16 that will be redirected to higher somatosensory areas via extended reality 1 18, visual 123, auditory 120 and/or haptic 121 feedback [4, 5].

[00034] Off-the-shelf known pharmacological adjuncts (e.g., buspirone) with an established safety profile utilised in prior studies [6-10] can be added to measure their additive effect on neural plasticity. The system 100 is designed to retrofit and update existing, commercially available equipment 104.

[00035] A person skilled in the art will appreciate that many embodiments and variations can be made without departing from the ambit of the present invention.

[00036] The system 100 may further include an actuator, such as a robotic motor coupled to the drive crank, for actuating the exercise equipment 104. In use, the model 1 10 actuates the actuator to some extent to assist the person 102.

[00037] In compliance with the statute, the invention has been described in language more or less specific to structural or methodical features. It is to be understood that the invention is not limited to specific features shown or described since the means herein described comprises preferred forms of putting the invention into effect.

[00038] Reference throughout this specification to‘one embodiment’ or‘an embodiment’ means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the appearance of the phrases‘in one embodiment’ or‘in an embodiment’ in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more combinations.

[00039] References 1 . [Intentionally left blank]2. Brito da Luz S, Modenese L, Sancisi N, Mills PM, Kennedy B, Beck BR, et al. Feasibility of using MRIs to create subject-specific parallel- mechanism joint models. J Biomech 2017; 53: 45-55.

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Bioinspired Technologies to Connect Musculoskeletal Mechanobiology to the Person for Training and Rehabilitation. Front Comput Neurosci 2017; 1 1 : 96.

5. Pizzolato C, Reggiani M, Modenese L, Lloyd DG. Real-time inverse kinematics and inverse dynamics for lower limb applications using OpenSim. Comput Methods Biomech Biomed Engin 2017; 20: 436-445.

6. van den Brand R, Heutschi J, Barraud Q, DiGiovanna J, Bartholdi K, Huerlimann M, et al. Restoring voluntary control of locomotion after paralyzing spinal cord injury. Science 2012; 336: 1 182-1 185.

7. Gerasimenko YP, Lu DC, Modaber M, Zdunowski S, Gad P, Sayenko DG, et al. Noninvasive Reactivation of Motor Descending Control after Paralysis. J Neurotrauma 2015; 32: 1968-1980.

8. Sayenko D, Rath M, Ferguson AR, Burdick J, Havton L, Edgerton VRPD, et al. Self-assisted standing enabled by non-invasive spinal stimulation after spinal cord injury. J Neurotrauma 2018.

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Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med 2018; 24: 1677-1682.

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