Objective
Chronic stroke patients with severe hand weakness, respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine-interface training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double blind sham-controlled design proof of concept study.
Methods
32 chronic stroke patients with severe hand weakness, were randomly assigned to two matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms (SMR) with contingent online movements of hand and arm orthoses (experimental group , n=16). In the control group (sham group, n=16) movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects and functional magnetic resonance imaging (MRI) blood oxygenation level dependent activity were assessed before and after intervention.
Results
A significant group × time interaction in upper limb Fugl-Meyer motor (cFMA) scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41±0.563 points difference, p=0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in functional MRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups.
Interpretation
The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation.