Hemiparetic Stroke Rehabilitation Using Avatar and Electrical Stimulation Based on Non-invasive Brain Computer Interface

Abstract

Brain computer interfaces (BCIs) have been employed in rehabilitation training for post-stroke patients. Patients in the chronic stage, and/or with severe paresis, are particularly challenging for conventional rehabilitation. We present results from two such patients who participated in BCI training with first-person avatar feedback. Five assessments were conducted to assess any behavioural changes after the intervention, including the upper extremity Fugl-Meyer assessment (UE-FMA) and 9 hole-peg test (9HPT). Patient 1 (P1) increased his UE-FMA score from 25 to 46 points after the intervention. He could not perform the 9HPT in the first session. After the 18 th session, he was able to perform the 9HPT and reduced the time from 10 min 22 sec to 2 min 53 sec. Patient 2 (P2) increased her UE-FMA from 17 to 28 points after the intervention. She could not perform the 9HPT throughout the training session. However, she managed to complete the test in 17 min 17 sec during the post-assessment session. These results show that the feasibility of this BCI approach with chronic patients with severe paresis, and further support the growing consensus that these types of tools might develop into a new paradigm for rehabilitation tool for stroke patients. However, the results are from only two chronic stroke patients. This approach should be further validated in broader randomized controlled studies involving more patients.

A systematic review on functional electrical stimulation based rehabilitation systems for upper limb post-stroke recovery

“…Based on the assessment, 7 studies were determined to be of "good quality", while 4 studies were evaluated as "fair quality" (Supplementary Table S1). In addition, five case reports (23,37,38,40,42) were included and appraised using the "Joanna Briggs Institute (JBI) Critical Appraisal" tool. The overall quality of each case report was "good" based on the JBI checklist (Supplementary Table S2).…”

“…Reported RCTs (17, 32-36, 51, 55, 56) and feasibility studies (19,21,23,24,38,42,44,58) claimed statistical significance results; however, their sample size is not large enough (lies between 1 and 51 stroke patients in one group). According to Kaptein (94), a conventional RCT requires a group size of at least 64 individuals in each group to obtain statistically significant results.…”

“…Thus, the EEG signal is used to generate a muscle electrical stimulation pattern that matches the intended movements of user (the user imagines and tries to perform that movement). Such MI-BCI methods with FES systems have widely been used in stroke rehabilitation for motor and functional recovery (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

Workshops of the seventh international brain-computer interface meeting: not getting lost in translation

“…At the same time, a VR avatar shows the same movement on a computer screen in front of the patient. Preliminary data of a clinical study shows a Fugl-Meyer Score improvement of 8 points in sub-acute and chronic patients (N = 25, p < 0.0001) and patients achieve a high BCI classification accuracy [121,122]. José Millán presented a clinical study showing that BCI coupled to FES elicits significant, clinically relevant, and lasting motor recovery of arm and hand function in chronic stroke survivors, while this was not the case for sham FES where stimulation was random and not contingent on cortical patterns of motor activity indicating attempted movement [123].…”

BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities

“…All patients achieved high control accuracies and exhibited improvements in motor function. In a later study, Cho et al [23] present the results of two patients who performed the BCI training with first-person avatar feedback. After the study, both patients reported improvements in motor functions and both have improved their scores on Upper Extremity Fugl-Meyer Assessment scale.…”