Challenges and Opportunities for the Future of Brain-Computer Interface in Neurorehabilitation

Abstract

Brain-computer interfaces (BCIs) provide a unique technological solution to circumvent the damaged motor system. For neurorehabilitation, the BCI can be used to translate neural signals associated with movement intentions into tangible feedback for the patient, when they are unable to generate functional movement themselves. Clinical interest in BCI is growing rapidly, as it would facilitate rehabilitation to commence earlier following brain damage and provides options for patients who are unable to partake in traditional physical therapy. However, substantial challenges with existing BCI implementations have prevented its widespread adoption. Recent advances in knowledge and technology provide opportunities to facilitate a change, provided that researchers and clinicians using BCI agree on standardisation of guidelines for protocols and shared efforts to uncover mechanisms. We propose that addressing the speed and effectiveness of learning BCI control are priorities for the field, which may be improved by multimodal or multi-stage approaches harnessing more sensitive neuroimaging technologies in the early learning stages, before transitioning to more practical, mobile implementations. Clarification of the neural mechanisms that give rise to improvement in motor function is an essential next step towards justifying clinical use of BCI. In particular, quantifying the unknown contribution of non-motor mechanisms to motor recovery calls for more stringent control conditions in experimental work. Here we provide a contemporary viewpoint on the factors impeding the scalability of BCI. Further, we provide a future outlook for optimal design of the technology to best exploit its unique potential, and best practices for research and reporting of findings.

Ipsilesional Mu Rhythm Desynchronization Correlates With Improvements in Affected Hand Grip Strength and Functional Connectivity in Sensorimotor Cortices Following BCI-FES Intervention for Upper Extremity in Stroke Survivors

“…Our results are in line with findings of other studies that have employed similar BCI paradigms in cohorts of stroke survivors with similar demographics (Daly et al, 2009;Ramos-Murguialday et al, 2013;Ang et al, 2014;Ono et al, 2014;Popovic, 2014;Hu et al, 2015;Kim et al, 2016;Biasiucci et al, 2018;Nishimoto et al, 2018;Tabernig et al, 2018;Bai et al, 2020;Simon et al, 2021). For example, Biasiucci et al (2018) report that only their BCI-FES group exhibited significant functional improvement following BCI intervention.…”

“…A growing body of evidence supports the effectiveness of EEG-based BCIs on improvement of upper extremity motor function following stroke (for meta-analyses/reviews see Cervera et al, 2018;Bai et al, 2020;Simon et al, 2021). BCI paradigms utilizing FES and/or attempted voluntary movements of the hemiparetic hand are particularly promising interventions for the rehabilitation of stroke survivors (Ramos-Murguialday et al, 2013;Kim et al, 2016;Biasiucci et al, 2018;Nishimoto et al, 2018;Remsik et al, 2018;Tabernig et al, 2018) because they may induce and/or facilitate neuroplastic changes, at both structural and functional levels, that link movement intention with muscle contraction (Daly and Wolpaw, 2008;Ramos-Murguialday et al, 2013;Biasiucci et al, 2018;Bai et al, 2020).…”

“…BCI-mediated FES leads to the most significant recovery of motor function following stroke (Bai et al, 2020;Simon et al, 2021). The inclusion of FES is thought to contribute to the clinical effect of a BCI not only through the somatosensory contribution of facilitated muscle stimulation but also through pairing of volitionally modified CNS efferent signals with stimulation (i.e., activation) of the impaired distal muscle (Bergquist et al, 2011).…”

“…Future research is needed to better identify and track the genesis and progression of neuroplastic changes, and to determine the relative importance of the various intra-and interhemispheric network connectivity changes presented here. In addition, further research is necessary to discover the mechanistic origins of any such neuroplasticity, and how such mechanism(s) may improve rehabilitation strategies that enable caregivers to provide maximal benefit to patients (Bai et al, 2020;Simon et al, 2021).…”

BCI-FES With Multimodal Feedback for Motor Recovery Poststroke

“…Recent evidence suggest that BCI-FES is an effective means of delivering treatment beyond traditional clinical windows and BCI-FES designs may be more effective than other existing BCI designs (Biasiucci et al, 2018;Simon et al, 2021). The optimal inclusion of adjuvants and the physical design of a BCI system for stroke motor rehabilitation are yet undefined in the field.…”