Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface

Abstract

Introduction Brain computer interface is an emerging technology to treat the sequelae of stroke. The purpose of this study was to explore the motor imagery related desynchronization of sensorimotor rhythms of stroke patients and to assess the efficacy of an upper limb neurorehabilitation therapy based on functional electrical stimulation controlled by a brain computer interface. Methods Eight severe chronic stroke patients were recruited. The study consisted of two stages: screening and therapy. During screening, the ability of patients to desynchronize the contralateral oscillatory sensorimotor rhythms by motor imagery of the most affected hand was assessed. In the second stage, a therapeutic intervention was performed. It involved 20 sessions where an electrical stimulator was activated when the patient's cerebral activity related to motor imagery was detected. The upper limb was assessed, before and after the intervention, by the Fugl–Meyer score (primary outcome). Spasticity, motor activity, range of movement and quality of life were also evaluated (secondary outcomes). Results Desynchronization was identified in all screened patients. Significant post-treatment improvement ( p < 0.05) was detected in the primary outcome measure and in the majority of secondary outcome scores. Conclusions The results suggest that the proposed therapy could be beneficial in the neurorehabilitation of stroke individuals.

Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis

“…A total of 1015 records were screened, of which the full texts of 80 were assessed for eligibility. Finally, 33 studies were included in the current systematic review [6, 7, 15-17, 26, 35, 37, 46, 47, 49-71], of which 18 studies were of single-group design [26,37,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71], and 15 studies were of controlled-trial design [6, 7, 15-17, 35, 46, 47, 49-55]. In the current review, only studies with a controlled-trial design were included in our metaanalysis, and those with single-group designs were only included in our qualitative description.…”

Differential Effect of Visual and Proprioceptive Stimulation on Corticospinal Output for Reciprocal Muscles

“…To clarify the spinal and cortical mechanisms related to visual and proprioceptive information, future studies should consider performing a detailed examination using TMS, peripheral nerve stimulation, and brain imaging methods. In addition, previous studies have suggested that therapy using motor imagery (Tabernig et al, 2018; Geiger et al, 2019) or vibration (Ahn et al, 2019; Toscano et al, 2019) could be beneficial in the neurorehabilitation of patients with stroke. Although we investigated whether the corticospinal excitabilities for reciprocal muscles were differentially affected by visuo-proprioceptive tasks, further studies should investigate whether engaging in combined observation and vibration can facilitate motor recovery of reciprocal muscles in patients.…”

Decoding Hand Motor Imagery Tasks Within the Same Limb From EEG Signals Using Deep Learning

“…3 show the coefficient of determination r 2 distributed over topographical maps for the left and right sides, respectively. A threshold of 0.2 was defined to consider an r 2 value as significant; it was based on r 2 values from similar approaches [7], [19], [20], [39]. The right side had more significant differences between both groups than the left side for the flexion and extension MI tasks; there were no significant differences for the grasping MI task for both sides.…”

“…A brain-computer interface (BCI) can decode brain activity and translate motor intention to commands that can control devices; such as a computer [1], a virtual keyboard [2], an orthosis [3], [4], a functional electrical stimulator (FES) [5]- [7], and assistive robots [8]- [10]. Non-invasive methods record brain activity generally, such as electroencephalography (EEG); it is the most commonly adopted technology owing to be practical and affordable in comparison with other methods [11].…”

“…It also enhanced the training efficiency and grasp control performance of able-bodied subjects using a virtual reality (VR) hand rehabilitation platform [16] in comparison with visual and no feedbacks conditions. BCI-FES systems were tested with post-stroke patients [7], [17], improving their upper-limb motor function and restoring the voluntary reaching function in some cases. In addition, BCI-FES in able-bodied subjects produced greater ERD powers than those of MI-FES, MI, and FES sessions [18]; and improved MI learning [5].…”