scholarly journals Effect of brain-computer interface training based on non-invasive electroencephalography using motor imagery on functional recovery after stroke - a systematic review and meta-analysis

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Antje Kruse ◽  
Zorica Suica ◽  
Jan Taeymans ◽  
Corina Schuster-Amft
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Motor Imagery ◽  
Brain Function ◽  
Conventional Therapy ◽  
Brain Computer Interface ◽  
Meta Analysis ◽  
Motor Recovery ◽  
Computer Interface ◽  
Function Recovery

Abstract Background Training with brain-computer interface (BCI) technology in the rehabilitation of patients after a stroke is rapidly developing. Numerous RCT investigated the effects of BCI training (BCIT) on recovery of motor and brain function in patients after stroke. Methods A systematic literature search was performed in Medline, IEEE Xplore Digital Library, Cochrane library, and Embase in July 2018 and was repeated in March 2019. RCT or controlled clinical trials that included BCIT for improving motor and brain recovery in patients after a stroke were identified. Data were meta-analysed using the random-effects model. Standardized mean difference (SMD) with 95% confidence (95%CI) and 95% prediction interval (95%PI) were calculated. A meta-regression was performed to evaluate the effects of covariates on the pooled effect-size. Results In total, 14 studies, including 362 patients after ischemic and hemorrhagic stroke (cortical, subcortical, 121 females; mean age 53.0+/− 5.8; mean time since stroke onset 15.7+/− 18.2 months) were included. Main motor recovery outcome measure used was the Fugl-Meyer Assessment. Quantitative analysis showed that a BCI training compared to conventional therapy alone in patients after stroke was effective with an SMD of 0.39 (95%CI: 0.17 to 0.62; 95%PI of 0.13 to 0.66) for motor function recovery of the upper extremity. An SMD of 0.41 (95%CI: − 0.29 to 1.12) for motor function recovery of the lower extremity was found. BCI training enhanced brain function recovery with an SMD of 1.11 (95%CI: 0.64 to 1.59; 95%PI ranging from 0.33 to 1.89). Covariates such as training duration, impairment level of the upper extremity, and the combination of both did not show significant effects on the overall pooled estimate. Conclusion This meta-analysis showed evidence that BCI training added to conventional therapy may enhance motor functioning of the upper extremity and brain function recovery in patients after a stroke. We recommend a standardised evaluation of motor imagery ability of included patients and the assessment of brain function recovery should consider neuropsychological aspects (attention, concentration). Further influencing factors on motor recovery due to BCI technology might consider factors such as age, lesion type and location, quality of performance of motor imagery, or neuropsychological aspects. Trial Registration PROSPERO registration: CRD42018105832.

scholarly journals Combined action observation- and motor imagery-based brain computer interface (BCI) for stroke rehabilitation: a case report

2021 ◽  
Author(s):  
Nuttawat Rungsirisilp ◽  
Yodchanan Wongsawat
Keyword(s):  
Physical Therapy ◽  
Upper Extremity ◽  
Motor Function ◽  
Motor Imagery ◽  
Stroke Rehabilitation ◽  
Brain Activity ◽  
Brain Computer Interface ◽  
Action Observation ◽  
Activity Patterns ◽  
Computer Interface

Abstract Introduction: Upper extremity impairment is a problem usually found in poststroke patients, and it is seldom completely improved even following conventional physical therapy. Motor imagery (MI) and action observation (AO) therapy are mental practices that may regain motor function in poststroke patients, especially when integrating them with brain-computer interface (BCI) technology. However, previous studies have always investigated the effects of an MI- or AO-based BCI for stroke rehabilitation separately. Therefore, in this study, we aimed to propose the effectiveness of a combined AO and MI (AOMI)-based BCI with functional electrical stimulation (FES) feedback to improve upper limb functions and alter brain activity patterns in chronic stroke patients.Case presentation: A 53-year-old male who was 12 years post stroke was left hemiparesis and unable to produce any wrist and finger extension.Intervention: The participant was given an AOMI-based BCI with FES feedback 3 sessions per week for 4 consecutive weeks, and he did not receive any conventional physical therapy during the intervention. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and active range of motion (AROM) of wrist extension were used as clinical assessments, and the laterality coefficient (LC) value was applied to explore the altered brain activity patterns affected by the intervention.Outcomes: The FMA-UE score improved from 34 to 46 points, and the AROM of wrist extension was increased from 0 degrees to 20 degrees. LC values in the alpha band tended to be positive whereas LC values in the beta band seemed to be slightly negative after the intervention.Conclusion: An AOMI-based BCI with FES feedback training may be a promising strategy that could improve motor function in poststroke patients; however, its efficacy should be studied in a larger population and compared to that of other therapeutic methods.Trial registration: Thai Clinical Trial Registry: TCTR20200821002. Registered 17 August 2020, http://www.thaiclinicaltrials.org

scholarly journals 2190 Longitudinal changes in EEG power envelope connectivity are proportional to motor recovery in chronic stroke patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 17-17
Author(s):  
Joseph B. Humphries ◽  
David T. Bundy ◽  
Eric C. Leuthardt ◽  
Thy N. Huskey
Keyword(s):  
Motor Cortex ◽  
Motor Imagery ◽  
Stroke Rehabilitation ◽  
Brain Computer Interface ◽  
Chronic Stroke ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Computer Interface ◽  
Beta Band ◽  
Stroke Patients

OBJECTIVES/SPECIFIC AIMS: The objective of this study is to determine the degree to which the use of a contralesionally-controlled brain-computer interface for stroke rehabilitation drives change in interhemispheric motor cortical activity. METHODS/STUDY POPULATION: Ten chronic stroke patients were trained in the use of a brain-computer interface device for stroke recovery. Patients perform motor imagery to control the opening and closing of a motorized hand orthosis. This device was sent home with patients for 12 weeks, and patients were asked to use the device 1 hour per day, 5 days per week. The Action Research Arm Test (ARAT) was performed at 2-week intervals to assess motor function improvement. Before the active motor imagery task, patients were asked to quietly rest for 90 seconds before the task to calibrate recording equipment. EEG signals were acquired from 2 electrodes—one each centered over left and right primary motor cortex. Signals were preprocessed with a 60 Hz notch filter for environmental noise and referenced to the common average. Power envelopes for 1 Hz frequency bands (1–30 Hz) were calculated through Gabor wavelet convolution. Correlations between electrodes were then calculated for each frequency envelope on the first and last 5 runs, thus generating one correlation value per subject, per run. The chosen runs approximately correspond to the first and last week of device usage. These correlations were Fisher Z-transformed for comparison. The first and last 5 run correlations were averaged separately to estimate baseline and final correlation values. A difference was then calculated between these averages to determine correlation change for each frequency. The relationship between beta-band correlation changes (13–30 Hz) and the change in ARAT score was determined by calculating a Pearson correlation. RESULTS/ANTICIPATED RESULTS: Beta-band inter-electrode correlations tended to decrease more in patients achieving greater motor recovery (Pearson’s r=−0.68, p=0.031). A similar but less dramatic effect was observed with alpha-band (8–12 Hz) correlation changes (Pearson’s r=−0.42, p=0.22). DISCUSSION/SIGNIFICANCE OF IMPACT: The negative correlation between inter-electrode power envelope correlations in the beta frequency band and motor recovery indicates that activity in the motor cortex on each hemisphere may become more independent during recovery. The role of the unaffected hemisphere in stroke recovery is currently under debate; there is conflicting evidence regarding whether it supports or inhibits the lesioned hemisphere. These findings may support the notion of interhemispheric inhibition, as we observe less in common between activity in the 2 hemispheres in patients successfully achieving recovery. Future neuroimaging studies with greater spatial resolution than available with EEG will shed further light on changes in interhemispheric communication that occur during stroke rehabilitation.

scholarly journals Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Mengjiao Hu ◽  
Hsiao-Ju Cheng ◽  
Fang Ji ◽  
Joanna Su Xian Chong ◽  
Zhongkang Lu ◽  
...  
Keyword(s):  
Motor Function ◽  
Motor Imagery ◽  
Brain Computer Interface ◽  
Low Frequency ◽  
Computer Interface ◽  
Stroke Patients ◽  
Post Intervention ◽  
Functional Changes ◽  
Post Stroke ◽  
Assessment Scores

Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.

Abstract TP144: EEG-Based Brain Computer Interface Therapy for the Restoration of Distal Upper Extremity Motor Function

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander Remsik ◽  
Hemali Advani ◽  
Shruti Rajan ◽  
Kieth Dodd ◽  
Tyler Jacobson ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Visual Stimulation ◽  
Brain Computer Interface ◽  
Hand Movement ◽  
Performance Outcomes ◽  
Computer Interface ◽  
Non Invasive ◽  
Task Accuracy ◽  
Post Therapy

Introduction: This current study is part of a larger, on-going clinical trial (NCT02098265), which evaluates non-invasive electroencephalographic (EEG) based brain-computer interface(BCI) therapy for restoration of distal upper extremity motor function in stroke survivors. We acquired data for 8 participants (mean age= 64 years) presenting with varying levels of upper-extremity motor deficits and chronicity since stroke. EEG based BCI task-related performance outcomes were compared with distal extremity behavioral testing on the 9-Hole Peg Test - 9HPT) to illustrate the relationship of BCI training performance on behavioral performance. Methods: EEG data is acquired with BCI2000, a 16 channel recording system (g.LADYbird-g. GAMMAsys-g. USBamp, Guger Technologies, Graz, Austria) with electrodes positioned according to the standard 10-20 system over the sensorimotor cortex at C3 & C4. Participants performed a hand movement task; randomly cued to move either their affected or unaffected hand depending on the appearance of virtual target and cursor on the screen. 9HPT Data was selected from two BCI conditions: 1) BCI with visual stimulus only, and 2) BCI with visual stimulation plus functional electrical stimulation (FES) of the impaired arm, and tongue stimulation (TS) at four time-points: baseline (prior to BCI therapy), mid-point of BCI therapy, post-therapy, and one month post-therapy. Results: BCI visual plus stimulus for the unaffected side was found to best relate to 9HPT scores (p= 0.0928) with a trend to significance. BCI visual plus stimulus for the affected side was not shown to correlate with 9HPT scores (p= 0.2655). The results suggest that 9HPT scores better relate with average task accuracy when the TS and FES adjuvants are incorporated (BCI stimulus vs 9H PT unaffected p= 0.09284, BCI stimulus vs 9H PT affected p= 0.26553) compared to the BCI visual only task (BCI visual vs 9HPT unaffected p=0.2702, BCI visual vs 9HPT affected (p= 0.89276). Conclusion: Non-invasive EEG-based BCI therapy may be suitable for the restoration of distal upper extremity motor function but average task accuracy does not appear to be a valid indicator of motor improvement. This finding suggests that visual only BCI systems are inadequate for motor rehabilitation.

scholarly journals A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke

2016 ◽  
Vol 13 (5) ◽  
pp. 445-454 ◽  
Author(s):  
Alexander Remsik ◽  
Brittany Young ◽  
Rebecca Vermilyea ◽  
Laura Kiekhoefer ◽  
Jessica Abrams ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Brain Computer Interface ◽  
Computer Interface

scholarly journals Brain-computer-interface technology with multisensory feedback for controlled ideomotor training in the rehabilitation of stroke patients

2019 ◽  
pp. 27-32
Author(s):  
Yu.V. Bushkova ◽  
G.E. Ivanova ◽  
L.V. Stakhovskaya ◽  
A.A. Frolov
Keyword(s):  
Motor Imagery ◽  
Upper Limb ◽  
Brain Computer Interface ◽  
Motor Recovery ◽  
Computer Interface ◽  
Robotic Hand ◽  
Stroke Patients ◽  
Factors Affecting ◽  
The Difference ◽  
Recovery Dynamics

Motor recovery of the upper limb is a priority in the neurorehabilitation of stroke patients. Advances in the brain-computer interface (BCI) technology have significantly improved the quality of rehabilitation. The aim of this study was to explore the factors affecting the recovery of the upper limb in stroke patients undergoing BCI-based rehabilitation with the robotic hand. The study recruited 24 patients (14 men and 10 women) aged 51 to 62 years with a solitary supratentorial stroke lesion. The lesion was left-hemispheric in 11 (45.6%) patients and right-hemispheric in 13 (54.4%) patients. Time elapsed from stroke was 4.0 months (3.0; 12.0). The median MoCa score was 25.0 (23.0; 27.0). The rehabilitation course consisted of 9.5 sessions (8.0; 10.0). We established a significant moderate correlation between motor imagery performance (the MIQ-RS score) and the efficacy of patient-BCI interaction. Patients with high MIQ-RS scores (47.5 (32.0; 54.0) achieved a better control of the BCI-driven hand exoskeleton (63.0 (54.0; 67.0), R = 0.67; p < 0.05). Recovery dynamics were more pronounced in patients with high MIQ-RS scores: the median score on the Fugl-Meyer Assessment scale was 14 (8.0; 16.0) points vs 10 (6.0; 13.0) points in patients with low MIQ-RS scores. However, the difference was not significant. Thus, we established a correlation between a patient’s ability for motor imagery (MIQ-RS) and the efficacy of patient-BCI interaction. A larger patient sample might be necessary to assess the effect of these factors on motor recovery dynamics.

scholarly journals PRINCIPLES OF MOTOR RECOVERY IN POST-STROKE PATIENTS USING HAND EXOSKELETON CONTROLLED BY THE BRAIN-COMPUTER INTERFACE BASED ON MOTOR IMAGERY

2017 ◽  
Vol 27 (1) ◽  
pp. 107-137 ◽  
Author(s):  
A. A. Frolov ◽  
Dušan Húsek ◽  
E. V. Biryukova ◽  
P. D. Bobrov ◽  
O. A. Mokienko ◽  
...  
Keyword(s):  
Motor Imagery ◽  
Brain Computer Interface ◽  
Motor Recovery ◽  
Computer Interface ◽  
Stroke Patients ◽  
Post Stroke ◽  
Hand Exoskeleton ◽  
The Brain

Brain–Computer Interface Training Based on Brain Activity Can Induce Motor Recovery in Patients With Stroke: A Meta-Analysis

2021 ◽  
pp. 154596832110628
Author(s):  
Ippei Nojima ◽  
Hisato Sugata ◽  
Hiroki Takeuchi ◽  
Tatsuya Mima
Keyword(s):  
Brain Activity ◽  
Brain Computer Interface ◽  
Meta Analysis ◽  
Self Regulation ◽  
Large Degree ◽  
Motor Recovery ◽  
Computer Interface ◽  
Assessment Scores ◽  
Before And After ◽  
Mean Differences

Background Brain–computer interface (BCI) is a procedure involving brain activity in which neural status is provided to the participants for self-regulation. The current review aims to evaluate the effect sizes of clinical studies investigating the use of BCI-based rehabilitation interventions in restoring upper extremity function and effective methods to detect brain activity for motor recovery. Methods A computerized search of MEDLINE, CENTRAL, Web of Science, and PEDro was performed to identify relevant articles. We selected clinical trials that used BCI-based training for post-stroke patients and provided motor assessment scores before and after the intervention. The pooled standardized mean differences of BCI-based training were calculated using the random-effects model. Results We initially identified 655 potentially relevant articles; finally, 16 articles fulfilled the inclusion criteria, involving 382 participants. A significant effect of neurofeedback intervention for the paretic upper limb was observed (standardized mean difference = .48, [.16-.80], P = .006). However, the effect estimates were moderately heterogeneous among the studies ( I2 = 45%, P = .03). Subgroup analysis of the method of measurement of brain activity indicated the effectiveness of the algorithm focusing on sensorimotor rhythm. Conclusion This meta-analysis suggested that BCI-based training was superior to conventional interventions for motor recovery of the upper limbs in patients with stroke. However, the results are not conclusive because of a high risk of bias and a large degree of heterogeneity due to the differences in the BCI interventions and the participants; therefore, further studies involving larger cohorts are required to confirm these results.

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

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Yi-Qian Hu ◽  
Tian-Hao Gao ◽  
Jie Li ◽  
Jia-Chao Tao ◽  
Yu-Long Bai ◽  
...  
Keyword(s):  
Motor Function ◽  
Motor Imagery ◽  
Upper Limb ◽  
Brain Computer Interface ◽  
Chronic Stroke ◽  
Computer Interface ◽  
Stroke Patients ◽  
Multimodal Feedback ◽  
Before And After ◽  
Extensor Carpi Radialis

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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