Abstract
Background
A
substantial number of clinical studies have demonstrated the functional
recovery induced by the use of brain-computer interface (BCI)
technology in patients after stroke. The objective of this review is to
evaluate the effect sizes of clinical studies investigating the use of
BCIs in restoring upper extremity function after stroke and the
potentiating effect of transcranial direct current stimulation (tDCS) on
BCI training for motor recovery.
Methods
The
databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and
PEDro) were systematically searched for eligible single-group or
clinical controlled studies regarding the effects of BCIs in hemiparetic
upper extremity recovery after stroke. Single-group studies were
qualitatively described, but only controlled-trial studies were included
in the meta-analysis. The PEDro scale was used to assess the
methodological quality of the controlled studies. A meta-analysis of
upper extremity function was performed by pooling the standardized mean
difference (SMD). Subgroup meta-analyses regarding the use of external
devices in combination with the application of BCIs were also carried
out. We summarized the neural mechanism of the use of BCIs on stroke.
Results
A
total of 1015 records were screened. Eighteen single-group studies and
15 controlled studies were included. The studies showed that BCIs seem
to be safe for patients with stroke. The single-group studies
consistently showed a trend that suggested BCIs were effective in
improving upper extremity function. The meta-analysis (of 12 studies)
showed a medium effect size favoring BCIs for improving upper extremity
function after intervention (SMD = 0.42; 95% CI = 0.18–0.66; I2 = 48%; P < 0.001;
fixed-effects model), while the long-term effect (five studies) was not
significant (SMD = 0.12; 95% CI = − 0.28 – 0.52; I2 = 0%; P = 0.540;
fixed-effects model). A subgroup meta-analysis indicated that using
functional electrical stimulation as the external device in BCI training
was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor imagery (P = 0.070).
The use of tDCS (two studies) could not further facilitate the effects
of BCI training to restore upper extremity motor function (SMD = − 0.30;
95% CI = − 0.96 – 0.36; I2 = 0%; P = 0.370; fixed-effects model).
Conclusion
The
use of BCIs has significant immediate effects on the improvement of
hemiparetic upper extremity function in patients after stroke, but the
limited number of studies does not support its long-term effects. BCIs
combined with functional electrical stimulation may be a better
combination for functional recovery than other kinds of neural feedback.
The mechanism for functional recovery may be attributed to the
activation of the ipsilesional premotor and sensorimotor cortical
network.
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