http://www.jneuroengrehab.com/content/12/1/57
1 Department of Biomedical Engineering, University of California, Irvine 92697, CA, USA
2 Department of Neurology, University of California, Irvine, Orange 92868, CA, USA
3 Department of Anatomy & Neurology, University of California, Irvine 92697, CA, USA
4 Department of Physical Medicine & Rehabilitation, University of California, Irvine, Orange 92868, CA, USA
5 Department of Electrical Engineering and Computer Science, University of California, Irvine 92697, CA, USA
2 Department of Neurology, University of California, Irvine, Orange 92868, CA, USA
3 Department of Anatomy & Neurology, University of California, Irvine 92697, CA, USA
4 Department of Physical Medicine & Rehabilitation, University of California, Irvine, Orange 92868, CA, USA
5 Department of Electrical Engineering and Computer Science, University of California, Irvine 92697, CA, USA
Journal of NeuroEngineering and Rehabilitation 2015, 12:57
doi:10.1186/s12984-015-0050-4
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/57
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/57
| Received: | 18 February 2015 |
| Accepted: | 23 June 2015 |
| Published: | 11 July 2015 |
© 2015 McCrimmon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
Background
Many stroke survivors have significant long-term gait impairment, often involving
foot drop. Current physiotherapies provide limited recovery. Orthoses substitute for
ankle strength, but they provide no lasting therapeutic effect. Brain-computer interface
(BCI)-controlled functional electrical stimulation (FES) is a novel rehabilitative
approach that may generate permanent neurological improvements. This study explores
the safety and feasibility of a foot-drop-targeted BCI-FES physiotherapy in chronic
stroke survivors.
Methods
Subjects (n = 9) operated an electroencephalogram-based BCI-FES system for foot dorsiflexion
in 12 one-hour sessions over four weeks. Gait speed, dorsiflexion active range of
motion (AROM), six-minute walk distance (6MWD), and Fugl-Meyer leg motor (FM-LM) scores
were assessed before, during, and after therapy. The primary safety outcome measure
was the proportion of subjects that deteriorated in gait speed by ≥0.16 m/s at one
week or four weeks post-therapy. The secondary outcome measures were the proportion
of subjects that experienced a clinically relevant decrease in dorsiflexion AROM (≥2.5°),
6MWD (≥20 %), and FM-LM score (≥10 %) at either post-therapy assessment.
Results
No subjects (0/9) experienced a clinically significant deterioration in gait speed,
dorsiflexion AROM, 6MWT distance, or FM-LM score at either post-therapy assessment.
Five subjects demonstrated a detectable increase (≥0.06 m/s) in gait speed, three
subjects demonstrated a detectable increase (≥2.5°) in dorsiflexion AROM, five subjects
demonstrated a detectable increase (≥10 %) in 6MWD, and three subjects demonstrated
a detectable increase (≥10 %) in FM-LM. Five of the six subjects that exhibited a
detectable increase in either post-therapy gait speed or 6MWD also exhibited significant
(p < 0.01 using a Mann–Whitney U test) increases in electroencephalogram event-related synchronization/desynchronization.
Additionally, two subjects experienced a clinically important increase (≥0.16 m/s)
in gait speed, and four subjects experienced a clinically important increase (≥20 %)
in 6MWD. Linear mixed models of gait speed, dorsiflexion AROM, 6MWD, and FM-LM scores
suggest that BCI-FES therapy is associated with an increase in lower motor performance
at a statistically, yet not clinically, significant level.
Conclusion
BCI-FES therapy is safe. If it is shown to improve post-stroke gait function in future
studies, it could provide a new gait rehabilitation option for severely impaired patients.
Formal clinical trials are warranted.
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