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The aim of this study concerns the evaluation and comparison of different Human-Machine Interfaces for the control of an upper limb motorized exoskeleton for severely impaired patients. Different approaches (i.e. manual, vocal, visual control) are tested in a simulation environment on three subjects affected by muscular dystrophy with the aim of assessing the capability of the system to interact with the user and vice versa. A Graphical User Interface shows the simulated behavior of the exoskeleton to the user which has to perform reaching tasks in the space by moving the exoskeleton endeffector to defined virtual targets that are displayed on the screen. Specific assessment of the interaction of the user with each control interface is achieved, while a quantitative evaluation of the usability of all the three approaches is provided by a System Usability Scale (SUS) questionnaire. All patients were able to interact with all control interfaces without difficulties and to complete reaching tasks in simulation. SUS scores showed overall good usability of the Human-Machine Control Interfaces suggesting that the manual and the vocal control interfaces are preferred by the subjects.

The systematic observation and imagination of actions promotes acquisition of motor skills. Furthermore, studies demonstrated that early sleep after practice enhances motor learning through an offline stabilization process. Here, we investigated behavioral effects and neurodynamical correlates of early sleep after action observation and motor imagery training (AO + MI-training) on motor learning in terms of manual dexterity. Forty-five healthy participants were randomized into three groups receiving a 3 week intervention consisting of AO + MI-training immediately before sleeping or AO + MI-training at least 12 h before sleeping or a control stimulation. AO + MI-training implied the observation and motor imagery of transitive manual dexterity tasks, whereas the control stimulation consisted of landscape video-clips observation. Manual dexterity was assessed using functional tests, kinematic and neurophysiological outcomes before and after the training and at 1-month follow-up. AO + MI-training improved manual dexterity, but subjects performing AO + MI-training followed by early sleep had significantly larger improvements than those undergoing the same training at least 12 h before sleeping. Behavioral findings were supported by neurodynamical correlates during motor performance and additional sleep-dependent benefits were also detected at 1 month follow-up. These findings introduce a new approach to enhance the acquisition of new motor skills or facilitate recovery in patients with motor impairments.

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