The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a study protocol for a randomized controlled trial to test early and long-term efficacy and to identify determinants of response

Mattia, Donatella; Pichiorri, Floriana; Colamarino, Emma; Masciullo, Marcella; Morone, Giovanni; Toppi, Jlenia; Pisotta, Iolanda; Tamburella, Federica; Lorusso, Matteo; Paolucci, Stefano; Puopolo, Maria; Cincotti, Febo; Molinari, Marco

doi:10.1186/s12883-020-01826-w

Cited by 29 publications

(24 citation statements)

References 43 publications

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“…The correlation between BCI accuracy and FMA improvement in this study indicated that BCI accuracy could influence training outcome in stroke patients, in agreement with previous reports [5,8,11]. The positive effect of BCI in post-stroke hand recovery is generally considered as the promotion of neural plasticity in previous studies [5,8,11,12,29]. The promising outcome of MI based BCI training to neurorehabilitation has been validated in a recent meta-analysis [30].…”

Section: Discussionsupporting

confidence: 89%

SSVEP-Based Brain Computer Interface Controlled Soft Robotic Glove for Post-Stroke Hand Function Rehabilitation

Guo

Wang

Duanmu

et al. 2022

IEEE Trans. Neural Syst. Rehabil. Eng.

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Soft robotic glove with brain computer interfaces (BCI) control has been used for post-stroke hand function rehabilitation. Motor imagery (MI) based BCI with robotic aided devices has been demonstrated as an effective neural rehabilitation tool to improve post-stroke hand function. It is necessary for a user of MI-BCI to receive a long time training, while the user usually suffers unsuccessful and unsatisfying results in the beginning. To propose another non-invasive BCI paradigm rather than MI-BCI, steady-state visually evoked potentials (SSVEP) based BCI was proposed as user intension detection to trigger the soft robotic glove for post-stroke hand function rehabilitation. Thirty post-stroke patients with impaired hand function were randomly and equally divided into three groups to receive conventional, robotic, and BCI-robotic therapy in this randomized control trial (RCT). Clinical assessment of Fugl-Meyer Motor Assessment of Upper Limb (FMA-UL), Wolf Motor Function Test (WMFT) and Modified Ashworth Scale (MAS) were performed at pre-training, post-training and three months follow-up. In comparing to other groups, The BCI-robotic group showed significant improvement after

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Section: Discussionsupporting

confidence: 89%

SSVEP-Based Brain Computer Interface Controlled Soft Robotic Glove for Post-Stroke Hand Function Rehabilitation

Guo

Wang

Duanmu

et al. 2022

IEEE Trans. Neural Syst. Rehabil. Eng.

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“…Concerning its potential to promote brain remodelling and structural restructuring, it has been widely applied in neurorehabilitation together with exoskeleton robots, functional electric stimulation, and other end-effectors [15,31,42,43]. Although, there was some heterogeneity among various studies, the effectiveness of BCI in motor recovery was worthy of affirmation [19,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…EEG is widely used because of its noninvasive, portability, and good temporal resolution. Researchers have demonstrated that MI-based BCI has the potential to be used in stroke rehabilitation [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Motor Imagery-Based Brain-Computer Interface Combined with Multimodal Feedback to Promote Upper Limb Motor Function after Stroke: A Preliminary Study

Gao

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Background. Recently, the brain-computer interface (BCI) has seen rapid development, which may promote the recovery of motor function in chronic stroke patients. Methods. Twelve stroke patients with severe upper limb and hand motor impairment were enrolled and randomly assigned into two groups: motor imagery (MI)-based BCI training with multimodal feedback (BCI group, n = 7) and classical motor imagery training (control group, n = 5). Motor function and electrophysiology were evaluated before and after the intervention. The Fugl-Meyer assessment-upper extremity (FMA-UE) is the primary outcome measure. Secondary outcome measures include an increase in wrist active extension or surface electromyography (the amplitude and cocontraction of extensor carpi radialis during movement), the action research arm test (ARAT), the motor status scale (MSS), and Barthel index (BI). Time-frequency analysis and power spectral analysis were used to reflect the electroencephalogram (EEG) change before and after the intervention. Results. Compared with the baseline, the FMA-UE score increased significantly in the BCI group ( p = 0.006). MSS scores improved significantly in both groups, while ARAT did not improve significantly. In addition, before the intervention, all patients could not actively extend their wrists or just had muscle contractions. After the intervention, four patients regained the ability to extend their paretic wrists (two in each group). The amplitude and area under the curve of extensor carpi radialis improved to some extent, but there was no statistical significance between the groups. Conclusion. MI-based BCI combined with sensory and visual feedback might improve severe upper limb and hand impairment in chronic stroke patients, showing the potential for application in rehabilitation medicine.

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“…They found a better clinical improvement in the NFB group with visual feedback compared to the MI group ( Pichiorri et al, 2015 ). Another ongoing study includes the same population from 1 to 6 months after stroke to evaluate the short and long-term efficacy of NFB training ( Mattia et al, 2020 ). They use visual ecological feedback with the participants’ own hands.…”

Section: Methodsmentioning

confidence: 99%

“…NFB training (Mattia et al, 2020). They use visual ecological feedback with the participants' own hands.…”

Section: Time-based Targetmentioning

confidence: 99%

Toward an Adapted Neurofeedback for Post-stroke Motor Rehabilitation: State of the Art and Perspectives

Franc

Altamira

Guillen

et al. 2022

Front. Hum. Neurosci.

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Stroke is a severe health issue, and motor recovery after stroke remains an important challenge in the rehabilitation field. Neurofeedback (NFB), as part of a brain–computer interface, is a technique for modulating brain activity using on-line feedback that has proved to be useful in motor rehabilitation for the chronic stroke population in addition to traditional therapies. Nevertheless, its use and applications in the field still leave unresolved questions. The brain pathophysiological mechanisms after stroke remain partly unknown, and the possibilities for intervention on these mechanisms to promote cerebral plasticity are limited in clinical practice. In NFB motor rehabilitation, the aim is to adapt the therapy to the patient’s clinical context using brain imaging, considering the time after stroke, the localization of brain lesions, and their clinical impact, while taking into account currently used biomarkers and technical limitations. These modern techniques also allow a better understanding of the physiopathology and neuroplasticity of the brain after stroke. We conducted a narrative literature review of studies using NFB for post-stroke motor rehabilitation. The main goal was to decompose all the elements that can be modified in NFB therapies, which can lead to their adaptation according to the patient’s context and according to the current technological limits. Adaptation and individualization of care could derive from this analysis to better meet the patients’ needs. We focused on and highlighted the various clinical and technological components considering the most recent experiments. The second goal was to propose general recommendations and enhance the limits and perspectives to improve our general knowledge in the field and allow clinical applications. We highlighted the multidisciplinary approach of this work by combining engineering abilities and medical experience. Engineering development is essential for the available technological tools and aims to increase neuroscience knowledge in the NFB topic. This technological development was born out of the real clinical need to provide complementary therapeutic solutions to a public health problem, considering the actual clinical context of the post-stroke patient and the practical limits resulting from it.

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The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a study protocol for a randomized controlled trial to test early and long-term efficacy and to identify determinants of response

Cited by 29 publications

References 43 publications

SSVEP-Based Brain Computer Interface Controlled Soft Robotic Glove for Post-Stroke Hand Function Rehabilitation

SSVEP-Based Brain Computer Interface Controlled Soft Robotic Glove for Post-Stroke Hand Function Rehabilitation

Motor Imagery-Based Brain-Computer Interface Combined with Multimodal Feedback to Promote Upper Limb Motor Function after Stroke: A Preliminary Study

Toward an Adapted Neurofeedback for Post-stroke Motor Rehabilitation: State of the Art and Perspectives

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