Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke

 Excuses, excuses; I'd have you all fired!

Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke

Martina Coscia, 1 Maximilian J. Wessel, 2,3 Ujwal Chaudary, 1 Jose ´ del R. Milla ´n, 4 Silvestro Micera, 5,6 Adrian Guggisberg, 7 Philippe Vuadens, 8 John Donoghue, 1,9 Niels Birbaumer 1,10, * and Friedhelm C. Hummel 2,3,7, * *These authors contributed equally to this work.  

 

Upper limb motor deficits in severe stroke survivors often remain unresolved over extended time periods. Novel neurotechnologies have the potential to significantly support upper limb motor restoration in severely impaired stroke individuals. Here, we review recent controlled clinical studies and reviews focusing on the mechanisms of action and effectiveness of single and combined technology-aided interventions for upper limb motor rehabilitation after stroke, including robotics, muscular electrical stimulation, brain stimulation and brain computer/machine interfaces. We aim at identifying possible guidance for the optimal use of these new technologies to enhance upper limb motor recovery especially in severe chronic stroke patients. We found that the current literature does not provide enough evidence to support strict guidelines,(Well then, our stroke leaders should do the fucking work that will prove which protocols will get chronic stroke survivors recovered. BUT with NO stroke leadership; nothing ever gets done!) because of the variability of the procedures for each intervention and of the heterogeneity of the stroke population. The present results confirm that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients, but the combination of interventions often lacks understanding of single intervention mechanisms of action, which may not reflect the summation of single intervention’s effectiveness. Stroke rehabilitation is a long and complex process, and one single intervention administrated in a short time interval cannot have a large impact for motor recovery, especially in severely impaired patients. To design personalized interventions combining or proposing different interventions in sequence, it is necessary to have an excellent understanding of the mechanisms determining the effectiveness of a single treatment in this heterogeneous population of stroke patients. We encourage the identification of objective biomarkers for stroke recovery for patients’ stratification and to tailor treatments. Furthermore, the advantage of longitudinal personalized trial designs compared to classical double-blind placebo-controlled clinical trials as the basis for precise personalized stroke rehabilitation medicine is dis- cussed. Finally, we also promote the necessary conceptual change from ‘one-suits-all’ treatments within in-patient clinical rehabili- tation set-ups towards personalized home-based treatment strategies, by adopting novel technologies merging rehabilitation and motor assistance, including implantable ones.  

 

1 Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland 2 Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland 3 Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), School of Life Sciences, Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Re ´adaptation, 1951 Sion, Switzerland 4 Defitech Chair in Brain-Machine Interface, Center for Neuroprosthetics, School of Engineering, E ´ cole Polytechnique Fe ´de ´rale de Lausanne (EPFL), Lausanne, 1015, Switzerland 5 Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, E ´ cole Polytechnique Fe ´de ´rale de Lausanne (EPFL), Lausanne, 1015, Switzerland 6 Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant’Anna, Pisa, 56025, Italy 7 Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland