Brain Computer Interface Treatment for Motor Rehabilitation of Upper Extremity of Stroke Patients-A Feasibility Study

Front Neurosci. 2020 Oct 21:14:591435. doi: 10.3389/fnins.2020.591435. eCollection 2020.


Introduction: Numerous recent publications have explored Brain Computer Interfaces (BCI) systems as rehabilitation tools to help subacute and chronic stroke patients recover upper extremity movement. Recent work has shown that BCI therapy can lead to better outcomes than conventional therapy. BCI combined with other techniques such as Functional Electrical Stimulation (FES) and Virtual Reality (VR) allows to the user restore the neurological function by inducing the neural plasticity through improved real-time detection of motor imagery (MI) as patients perform therapy tasks.

Methods: Fifty-one stroke patients with upper extremity hemiparesis were recruited for this study. All participants performed 25 sessions with the MI BCI and assessment visits to track the functional changes before and after the therapy.

Results: The results of this study demonstrated a significant increase in the motor function of the paretic arm assessed by Fugl-Meyer Assessment (FMA-UE), ΔFMA-UE = 4.68 points, P < 0.001, reduction of the spasticity in the wrist and fingers assessed by Modified Ashworth Scale (MAS), ΔMAS-wrist = -0.72 points (SD = 0.83), P < 0.001, ΔMAS-fingers = -0.63 points (SD = 0.82), P < 0.001. Other significant improvements in the grasp ability were detected in the healthy hand. All these functional improvements achieved during the BCI therapy persisted 6 months after the therapy ended. Results also showed that patients with Motor Imagery accuracy (MI) above 80% increase 3.16 points more in the FMA than patients below this threshold (95% CI; [1.47-6.62], P = 0.003). The functional improvement was not related with the stroke severity or with the stroke stage.

Conclusion: The BCI treatment used here was effective in promoting long lasting functional improvements in the upper extremity in stroke survivors with severe, moderate and mild impairment. This functional improvement can be explained by improved neuroplasticity in the central nervous system.

Keywords: BCI; Fugl-Meyer assessment; brain computer interfaces; functional electrical stimulation; neurorehabilitation; stroke; upper limb.