title: Evaluation of head orientation and neck muscle EMG signals as three-dimensional command sources.
abstract: BACKGROUND
  High cervical spinal cord injuries result in significant functional impairments and affect both the injured individual as well as their family and care givers. To help restore function to these individuals, multiple user interfaces are available to enable command and control of external devices. However, little work has been performed to assess the 3D performance of these interfaces.
  
  
  METHODS
  We investigated the performance of eight human subjects in using three user interfaces (head orientation, EMG from muscles of the head and neck, and a three-axis joystick) to command the endpoint position of a multi-axis robotic arm within a 3D workspace to perform a novel out-to-center 3D Fitts' Law style task. Two of these interfaces (head orientation, EMG from muscles of the head and neck) could realistically be used by individuals with high tetraplegia, while the joystick was evaluated as a standard of high performance. Performance metrics were developed to assess the aspects of command source performance. Data were analyzed using a mixed model design ANOVA. Fixed effects were investigated between sources as well as for interactions between index of difficulty, command source, and the five performance measures used. A 5% threshold for statistical significance was used in the analysis.
  
  
  RESULTS
  The performances of the three command interfaces were rather similar, though significant differences between command sources were observed. The apparent similarity is due in large part to the sequential command strategy (i.e., one dimension of movement at a time) typically adopted by the subjects. EMG-based commands were particularly pulsatile in nature. The use of sequential commands had a significant impact on each command source's performance for movements in two or three dimensions.
  
  
  CONCLUSIONS
  While the sequential nature of the commands produced by the user did not fit with Fitts' Law, the other performance measures used were able to illustrate the properties of each command source. Though pulsatile, given the overall similarity between head orientation and the EMG interface, (which also could be readily included in a future implanted neuroprosthesis) the use of EMG as a command source for controlling an arm in 3D space is an attractive choice.
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio. mrw8@case.edu.|Cleveland FES Center, Cleveland, Ohio. mrw8@case.edu.|Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. mrw8@case.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio. rfk3@case.edu.|Cleveland FES Center, Cleveland, Ohio. rfk3@case.edu.|Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. rfk3@case.edu.|MetroHealth Medical Center, Cleveland, Ohio. rfk3@case.edu.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D000465:Algorithms; D001696:Biomechanical Phenomena; D004576:Electromyography / Q000379:methods*; D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000502:physiology*; D009949:Orientation; D011782:Quadriplegia / Q000503:physiopathology; D011930:Reaction Time; D012371:Robotics; D013119:Spinal Cord Injuries / Q000503:physiopathology; D014584:User-Computer Interface; D055815:Young Adult