Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study

Abstract

Several studies have shown the positive clinical effect of brain computer interface (BCI) training for stroke rehabilitation. This study investigated the efficacy of the sensorimotor rhythm (SMR)-based BCI with audio-cue, motor observation and multisensory feedback for post-stroke rehabilitation. Furthermore, we discussed the interaction between training intensity and training duration in BCI training. Twenty-four stroke patients with severe upper limb (UL) motor deficits were randomly assigned to two groups: 2-week SMR-BCI training combined with conventional treatment (BCI Group, BG, n = 12) and 2-week conventional treatment without SMR-BCI intervention (Control Group, CG, n = 12). Motor function was measured using clinical measurement scales, including Fugl-Meyer Assessment-Upper Extremities (FMA-UE; primary outcome measure), Wolf Motor Functional Test (WMFT), and Modified Barthel Index (MBI), at baseline (Week 0), post-intervention (Week 2), and follow-up week (Week 4). EEG data from patients allocated to the BG was recorded at Week 0 and Week 2 and quantified by mu suppression means event-related desynchronization (ERD) in mu rhythm (8–12 Hz). All functional assessment scores (FMA-UE, WMFT, and MBI) significantly improved at Week 2 for both groups (p < 0.05). The BG had significantly higher FMA-UE and WMFT improvement at Week 4 compared to the CG. The mu suppression of bilateral hemisphere both had a positive trend with the motor function scores at Week 2. This study proposes a new effective SMR-BCI system and demonstrates that the SMR-BCI training with audio-cue, motor observation and multisensory feedback, together with conventional therapy may promote long-lasting UL motor improvement.Clinical Trial Registration: [http://www.chictr.org.cn], identifier [ChiCTR2000041119].

Brain-machine interface-based training for improving upper extremity function after stroke: A meta-analysis of randomized controlled trials

“…The mean age ranged from 41.6 ± 12.0 to 66.3 ± 4.53. With 6 months as the cut-off point between the subacute and chronic phases of the stroke, 11 studies were conducted on chronic stroke patients (Mihara et al, 2013 ; Ramos-Murguialday et al, 2013 ; Ang et al, 2014 , 2015 ; Kim et al, 2016 ; Biasiucci et al, 2018 ; Lin et al, 2018 ; Wang et al, 2018 ; Cheng et al, 2020 ; Lee et al, 2020 ; Miao et al, 2020 ), four studies were conducted on subacute stroke patients (Li et al, 2014 ; Pichiorri et al, 2015 ; Wu et al, 2019 ; Chen et al, 2020 ), and 2 studies included both chronic and subacute stroke patients (Frolov et al, 2017 ; Li et al, 2022 ). In 16 of the 17 studies, the BMI system relied on electroencephalography (EEG) to detect task-related changes in SMR.…”

“…Both chronic and subacute strokes have been extensively investigated previously. All studies were included in the subgroup analysis except Li et al ( 2022 ) that did not discuss the efficacy of the subacute and chronic phases separately. The subgroup analyses showed that BMI-based training significantly improved upper limb motor function in both chronic and subacute patients, and demonstrated modest (0.68) and large (1.11) effect sizes, respectively.…”

“…In this review, we performed a more comprehensive inclusion (17RCTs) covering RCTs from previously published meta-analyses, in addition to two uncited studies Wang et al ( 2018 ) and Li et al ( 2022 ). We aim to provide updated and higher quality evidence on the effectiveness and safety of BMI-based training in improving function in post-stroke patients.…”

Evidence of neuroplasticity with brain–computer interface in a randomized trial for post-stroke rehabilitation: a graph-theoretic study of subnetwork analysis

“…This result is consistent with previous studies on the effectiveness of BCI interventions for upper limb motor function recovery in stroke patients ( 53 ). However, Li et al ( 54 ) hold that apparent effects of the BCI intervention can occur at follow-up weeks for post-stroke patients. Add-on therapy of BCI training with conventional therapy may enhance upper extremity motor and brain function recovery in post-stroke patients ( 55 ).…”

Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke—A network meta-analysis of randomized controlled trials

“…The MBI consists of 10 items, including eating, bathing, grooming, dressing, stooling, urinating, toileting, transferring, walking and ascending and descending stairs and is often used to assess basic ADLs amongst subjects with strokes ( 96 , 158 ). The results of the NMA by Li et al ( 36 ) found that different modalities of BCI improved upper limb motor function and ADLs amongst subjects with strokes, with BCI and an FES as the driving device having the best effect ( 36 ).…”