A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke

And just why the fuck was this research needed when this from 2010 already proved it worked? God the absolute stupidity in the stroke medical world is universe class stupidity. Write up stroke protocols and get them distributed worldwide and this waste of time could be prevented.

Patients Gain Limb Movement Years After Stroke April 2010

 

A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke

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Kai Keng Ang, Karen Sui Geok Chua, Kok Soon Phua, ...

First Published April 21, 2014 Research Article

https://doi.org/10.1177/1550059414522229

Article information

Abstract

Electroencephalography (EEG)–based motor imagery (MI) brain-computer interface (BCI) technology has the potential to restore motor function by inducing activity-dependent brain plasticity. The purpose of this study was to investigate the efficacy of an EEG-based MI BCI system coupled with MIT-Manus shoulder-elbow robotic feedback (BCI-Manus) for subjects with chronic stroke with upper-limb hemiparesis. In this single-blind, randomized trial, 26 hemiplegic subjects (Fugl-Meyer Assessment of Motor Recovery After Stroke [FMMA] score, 4-40; 16 men; mean age, 51.4 years; mean stroke duration, 297.4 days), prescreened with the ability to use the MI BCI, were randomly allocated to BCI-Manus or Manus therapy, lasting 18 hours over 4 weeks. Efficacy was measured using upper-extremity FMMA scores at weeks 0, 2, 4 and 12. ElEG data from subjects allocated to BCI-Manus were quantified using the revised brain symmetry index (rBSI) and analyzed for correlation with the improvements in FMMA score. Eleven and 15 subjects underwent BCI-Manus and Manus therapy, respectively. One subject in the Manus group dropped out. Mean total FMMA scores at weeks 0, 2, 4, and 12 weeks improved for both groups: 26.3 ± 10.3, 27.4 ± 12.0, 30.8 ± 13.8, and 31.5 ± 13.5 for BCI-Manus and 26.6 ± 18.9, 29.9 ± 20.6, 32.9 ± 21.4, and 33.9 ± 20.2 for Manus, with no intergroup differences (P = .51). More subjects attained further gains in FMMA scores at week 12 from BCI-Manus (7 of 11 [63.6%]) than Manus (5 of 14 [35.7%]). A negative correlation was found between the rBSI and FMMA score improvement (P = .044). BCI-Manus therapy was well tolerated and not associated with adverse events. In conclusion, BCI-Manus therapy is effective and safe for arm rehabilitation after severe poststroke hemiparesis. Motor gains were comparable to those attained with intensive robotic therapy (1,040 repetitions/session) despite reduced arm exercise repetitions using EEG-based MI-triggered robotic feedback (136 repetitions/session). The correlation of rBSI with motor improvements suggests that the rBSI can be used as a prognostic measure for BCI-based stroke rehabilitation.

Keywords stroke, rehabilitation, brain-computer interface, motor imagery, EEG

Introduction

BCI systems, using noninvasive EEG-based BCI technologies, are able to provide alternative channels using brain signals to support communication and control of assistive devices for subjects with severe motor disabilities.^1,2 Noninvasive BCI systems, based on sensorimotor rhythms, were able to achieve movement restoration in single patients with spinal cord lesions and chronic stroke for reaching and grasping.^3-5 There is now sufficient evidence that MI, the mental rehearsal of physical movement tasks, when combined with physical therapy leads to enhanced motor outcomes for stroke survivors and may represent a new approach to functional recovery after stroke.^6,7
Because MI is usually concealed within patients, EEG-based BCI can provide online measures of MI as neurofeedback to aid motor task execution.^8,9 An example is the modulation of sensorimotor rhythms, which are oscillations in the EEG occurring in the alpha (8 to12 Hz) and beta (18 to 26 Hz) bands. Modulation of these frequency bands is similarly observed during actual, as well as mentally rehearsed, or imagined movements. Another example is distinct phenomena such as event-related desynchronization (ERD) and synchronization (ERS), which are detectable on EEG during MI in healthy subjects.^4,10-13 Recent studies have also revealed that ERD and ERS can be enhanced using BCI with proprioceptive feedback¹⁴ or haptic feedback by closing the sensorimotor loop.¹⁵
There are currently a few clinical studies or protocols investigating the effects of noninvasive BCI on patients with chronic stroke.^16,17 Tan et al¹⁸ described successful BCI-triggered neuromuscular electrical stimulation of wrist and finger extensors in 4 of 6 stroke survivors with moderate to severe degrees of hand motor paresis. Because of long latency periods to trigger 1 BCI-activated neuromuscular electrical stimulation (42 seconds), fatigue was evident after about 1 hour of BCI practice. Do et al¹⁹ described a BCI functional electrical system to trigger foot dorsiflexion in healthy subjects. Buch et al²⁰ described 6 of 8 patients >1 year after stroke with severe finger extensor paralysis, who successfully learned to operate a magnetoencephalography (MEG)–based BCI device linked to a hand-opening and hand-closing orthotic system. Kaiser et al²¹ measured the ERD or ERS in 29 patients with stroke and found that higher impairment was related to stronger ERD in the unaffected hemisphere, and higher spasticity was related to stronger ERD in the affected hemisphere.²¹ However, these studies did not show clinical efficacy measurement on motor functions as a result of BCI-based intervention.
A case study of MEG-based BCI followed by EEG-based BCI combined with physiotherapy found significant clinical outcomes in FMMA scores (+84%).²² Positive results on functional magnetic resonance imaging (MRI) and diffusion tensor imaging in that case study suggested possible short-term BCI-induced cortical and ipsilesional corticospinal tract neuroplasticity. Mihara et al²³ recently presented the results of a randomized controlled trial in 10 stroke patients who received near-infrared spectroscopy–based BCI with visual feedback, compared with 10 who received near-infrared spectroscopy–based BCI with irrelevant feedback. Compared with the sham group, the patients who received BCI visual feedback showed significantly greater motor improvements, measured using the FMMA score. In addition, Ramos-Murguialday et al²⁴ recently presented the results of a randomized controlled trial of 16 patients with chronic stroke who received BCI with hand and arm orthotic feedback, compared with 14 who received random orthotic feedback not linked to BCI. Both groups received physiotherapy after the intervention. Patients who received BCI orthotic feedback showed significantly greater motor improvements, measured by combined hand and modified arm FMMA scores.
Hence, preliminary studies suggest that EEG-based MI BCI may be used to objectively assess the performance of MI to restore motor function.

Rationale

Because current BCI neurofeedback systems require pairing with effectors to complete the sensorimotor feedback loop for stroke, we sought to compare the effects of EEG-based BCI with robotic feedback versus manual robotic training using the commercially available MIT-Manus robot, here termed the BCI-Manus system (Interactive Motion Technologies USA, Watertown, MA). This device was chosen for its positive results in hemiplegic stroke and ability to safely deliver high-intensity repetitive training in a supported environment with reduced effort.²⁵
The aim of this study was to test the safety and efficacy of BCI-Manus compared with Manus therapy for subjects with chronic stroke with upper-limb hemiparesis. We describe the setup of an integrated BCI-Manus system and a randomized controlled trial comparing the BCI-Manus system with the Manus robot for moderate to severe chronic poststroke upper-limb hemiparesis.
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