Analysis of Prognostic Risk Factors Determining Poor Functional Recovery After Comprehensive Rehabilitation Including Motor-Imagery Brain-Computer Interface Training in Stroke Patients: A Prospective Study

Abstract

Objective: Upper limb (UL) motor function recovery, especially distal function, is one of the main goals of stroke rehabilitation as this function is important to perform activities of daily living (ADL). The efficacy of the motor-imagery brain-computer interface (MI-BCI) has been demonstrated in patients with stroke. Most patients with stroke receive comprehensive rehabilitation, including MI-BCI and routine training. However, most aspects of MI-BCI training for patients with subacute stroke are based on routine training. Risk factors for inadequate distal UL functional recovery in these patients remain unclear; therefore, it is more realistic to explore the prognostic factors of this comprehensive treatment based on clinical practice. The present study aims to investigate the independent risk factors that might lead to inadequate distal UL functional recovery in patients with stroke after comprehensive rehabilitation including MI-BCI (CRIMI-BCI).Methods: This prospective study recruited 82 patients with stroke who underwent CRIMI-BCI. Motor-imagery brain-computer interface training was performed for 60 min per day, 5 days per week for 4 weeks. The primary outcome was improvement of the wrist and hand dimensionality of Fugl-Meyer Assessment (δFMA-WH). According to the improvement score, the patients were classified into the efficient group (EG, δFMA-WH > 2) and the inefficient group (IG, δFMA-WH ≤ 2). Binary logistic regression was used to analyze clinical and demographic data, including aphasia, spasticity of the affected hand [assessed by Modified Ashworth Scale (MAS-H)], initial UL function, age, gender, time since stroke (TSS), lesion hemisphere, and lesion location.Results: Seventy-three patients completed the study. After training, all patients showed significant improvement in FMA-UL (Z = 7.381, p = 0.000**), FMA-SE (Z = 7.336, p = 0.000**), and FMA-WH (Z = 6.568, p = 0.000**). There were 35 patients (47.9%) in the IG group and 38 patients (52.1%) in the EG group. Multivariate analysis revealed that presence of aphasia [odds ratio (OR) 4.617, 95% confidence interval (CI) 1.435–14.860; p < 0.05], initial FMA-UL score ≤ 30 (OR 5.158, 95% CI 1.150–23.132; p < 0.05), and MAS-H ≥ level I+ (OR 3.810, 95% CI 1.231–11.790; p < 0.05) were the risk factors for inadequate distal UL functional recovery in patients with stroke after CRIMI-BCI.Conclusion: We concluded that CRIMI-BCI improved UL function in stroke patients with varying effectiveness. Inferior initial UL function, significant hand spasticity, and presence of aphasia were identified as independent risk factors for inadequate distal UL functional recovery in stroke patients after CRIMI-BCI.

A Cross-Sectional Study: Determining Factors of Functional Independence and Quality of Life of Patients One Month after Having Suffered a Stroke

“…Previous studies also found that age, gender and type of stroke predict long-term functional outcome after discharge [21,38]. Another study also corroborates our results, indicating that age influences performance and, therefore, may be a prognostic factor for motor function after a stroke [19].…”

“…Previous studies report that the degree of motor impairment at baseline may influence the incidence of post-stroke medical complications, which may imply worse functional outcomes months after stroke [44]. Likewise, it is also suggested that other complications, such as the presence of depression, cognitive impairment, aphasia or unilateral negligence, were also factors that affected the recovery of motor function [19]. In other investigations, it can be confirmed that a greater functional impairment and the presence of pre-stroke dependency may also be associated with a worse short-and long-term subsequent functional prognosis [45].…”

“…Regarding its prognosis, multiple factors affect the development and functional recovery of the upper limb, such as the great variability in performance between individuals, cognitive, sensory and motor function, psychological factors, age, gender and the dominant hand [19]. Functional impairment is the most common consequence, in addition to cognitive impairment [20], which can lead to greater dependence on ADL performance, job loss and decreased QoL [21].…”

Motor Imagery Recognition Method Based on Multisource Transfer Learning and Multiclassifier Fusion

“…This causes the data distribution of MI to be significantly different. Thus, it significantly affects the generalization and stability of MI recognition based on traditional machine learning methods, such as logistic regression (LR) [4,5], support vector machine (SVM) [6,7], linear discriminant analysis (LDA) [8,9], and artificial neural network (ANN) [10,11].…”

Efectos de la Terapia en Espejo vs. Ejercicio Terapéutico Cognoscitivo en la mejora de las funciones del miembro superior en pacientes con ictus

“…Es importante destacar de nuevo, que la recuperación de cada persona es un proceso individual y que éstos y otros muchos factores pueden interactuar de formas complejas, afectando el pronóstico de cada paciente de forma única. Por ello, la evaluación y el seguimiento por parte de un equipo multidisciplinar especializado son esenciales para optimizar la recuperación funcional tras un ictus [145][146][147].…”