Proof of principle of a brain-computer interface approach to support poststroke arm rehabilitation in hospitalized patients: design, acceptability, and usability

Abstract

Objective: To evaluate the feasibility of brain-computer interface (BCI)-assisted motor imagery training to support hand/arm motor rehabilitation after stroke during hospitalization.

Design: Proof-of-principle study.

Setting: Neurorehabilitation hospital.

Participants: Convenience sample of patients (N=8) with new-onset arm plegia or paresis caused by unilateral stroke.

Interventions: The BCI-based intervention was administered as an "add-on" to usual care and lasted 4 weeks. Under the supervision of a therapist, patients were asked to practice motor imagery of their affected hand and received as a discrete feedback the movements of a "virtual" hand superimposed on their own. Such a BCI-based device was installed in a rehabilitation hospital ward.

Main outcome measures: Following a user-centered design, we assessed system usability in terms of motivation, satisfaction (by means of visual analog scales), and workload (National Aeronautics and Space Administration-Task Load Index). The usability of the BCI-based system was also evaluated by 15 therapists who participated in a focus group.

Results: All patients successfully accomplished the BCI training. Significant positive correlations were found between satisfaction and motivation (P=.001, r=.393). BCI performance correlated with interest (P=.027, r=.257) and motivation (P=.012, r=.289). During the focus group, professionals positively acknowledged the opportunity offered by BCI-assisted training to measure patients' adherence to rehabilitation.

Conclusions: An ecological BCI-based device to assist motor imagery practice was found to be feasible as an add-on intervention and tolerable by patients who were exposed to the system in the rehabilitation environment.

Keywords: Brain-computer interfaces; Rehabilitation; Stroke.