The Application of Brain-Computer Interface in Upper Limb Dysfunction After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

ObjectiveThis study aimed to examine the effectiveness and safety of the Brain-computer interface (BCI) in treatment of upper limb dysfunction after stroke.MethodsEnglish and Chinese electronic databases were searched up to July 2021. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane’s risk-of-bias tool. Meta-analysis was performed using RevMan 5.4.ResultsA total of 488 patients from 16 RCTs were included. The results showed that (1) the meta-analysis of BCI-combined treatment on the improvement of the upper limb function showed statistical significance [standardized mean difference (SMD): 0.53, 95% CI: 0.26–0.80, P < 0.05]; (2) BCI treatment can improve the abilities of daily living of patients after stroke, and the analysis results are statistically significant (SMD: 1.67, 95% CI: 0.61–2.74, P < 0.05); and (3) the BCI-combined therapy was not statistically significant for the analysis of the Modified Ashworth Scale (MAS) (SMD: −0.10, 95% CI: −0.50 to 0.30, P = 0.61).ConclusionThe meta-analysis indicates that the BCI therapy or BCI combined with other therapies such as conventional rehabilitation training and motor imagery training can improve upper limb dysfunction after stroke and enhance the quality of daily life.

Brain-computer interface combined with mental practice and occupational therapy enhances upper limb motor recovery, activities of daily living, and participation in subacute stroke

“…An interesting result was that the control group showed a significant response in two of the four scales for the primary outcome (MAL-qualitative and quantitative and in the BBT), with the effect size for the experimental group being larger. Similar results were observed in a randomized clinical trial using BCI in combination with other therapies, where both groups showed functional improvement after the interventions (55). However, the functional gains obtained on standardized scales were greater in the experimental group, demonstrating the positive role of BCI in post-stroke rehabilitation.…”

“…Brain-computer interface is a promising strategy for treating and recovering functions, specifically UL motor skills ( 55 ). A meta-analytic study with 235 subjects suggested that BCI may be an effective intervention for post-stroke UL motor rehabilitation ( 6 ).…”

“…In the same sense, it is clinically known that improvement in motor skills does not always mean improvement in functional independence and performance in ADL. Few studies using the BCI clearly showed functional motor responses in the UL ( 18 , 55 , 56 ). However, the question remains whether UL motor improvements can favor performance in ADL.…”

Identifying Thematics in a Brain‐Computer Interface Research

“…These terms include “signal possessing” or “signal analysis” [ 6 , 7 , 19 , 52 ]. Medical-associated words such as “stroke” and “rehabilitation” were seen to remain in use [ 64 , 71 , 76 , 78 , 85 ]; this is reflected in the shift of focus from understanding how the brain functions after a stroke to more practical applications identifying functional brain pathways using“motor imagery” [ 7 , 36 , 70 , 79 , 89 ] and its practical application with “upper limb” [ 84 , 85 ], or “upper extremity” [ 86 ] and “lower limb” [ 84 ].…”

“…EEG has also been used to detect mental commands for the operation of wheelchairs after spinal cord injury or neuromuscular disease and has extensively been used in stroke rehabilitation and external device control [35,43]. EEG systems in stroke victims have been efective in returning upper body control after rehabilitation [76,[83][84][85][86].…”