Brain‐computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations, enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here, we provide a first meta‐analysis evaluating the clinical effectiveness of BCI‐based post‐stroke motor rehabilitation. Trials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post‐stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random‐effects inverse variance method was used to calculate the summary effect size. We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post‐stroke survivors that fulfilled the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta‐analysis. Motor improvements, mostly quantified by the upper limb Fugl‐Meyer Assessment (FMA‐UE), exceeded the minimal clinically important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was associated with a standardized mean difference of 0.79 (95% CI: 0.37 to 1.20) in FMA‐UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI‐induced functional and structural neuroplasticity at a subclinical level. This suggests that BCI technology could be an effective intervention for post‐stroke upper limb rehabilitation. However, more studies with larger sample size are required to increase the reliability of these results.

BackgroundTechnology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.MethodsTen outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).ResultsAll participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.ConclusionsThis pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.

Objective. Abundant literature suggests the use of slow cortical potentials (SCPs) in a wide spectrum of basic and applied neuroscience areas. Due to their low signal to noise ratio, these potentials are often studied using grand-average analysis, which conceals trial-to-trial information. Moreover, most of the single trial analysis methods in the literature are based on classical electroencephalogram (EEG) features ([1-30] Hz) and are likely to be unsuitable for SCPs that have different signal properties (such as having the signal's spectral content in the range [0.2-0.7] Hz). In this paper we provide insights into the selection of appropriate parameters for spectral and spatial filtering. Approach. We study anticipation related SCPs recorded using a web-browser application protocol and a full-band EEG (FbEEG) setup from 11 subjects on two different days. Main results. We first highlight the role of a bandpass with [0.1-1.0] Hz in comparison with common practices (e.g., either with full dc, just a lowpass, or with a minimal highpass cut-off around 0.05 Hz). Secondly, we suggest that a combination of spatial-smoothing filter and common average reference (CAR) is more suitable than the spatial filters often reported in the literature (e.g., re-referencing to an electrode, Laplacian or CAR alone). Thirdly, with the help of these preprocessing steps, we demonstrate the generalization capabilities of linear classifiers across several days (AUC of 0.88 ± 0.05 on average with a minimum of 0.81 ± 0.03 and a maximum of 0.97 ± 0.01). We also report the possibility of further improvements using a Bayesian fusion technique applied to electrode-specific classifiers. Significance. We believe the suggested spatial and spectral preprocessing methods are advantageous for grand-average and single trial analysis of SCPs obtained from EEG, MEG as well as for electrocorticogram. The use of these methods will impact basic neurophysiological studies as well as the use of SCPs in the design of neuroprosthetics.

GG were employees of MindMaze SA, Switzerland and NB was an employee of Wyss Center, Switzerland. JU and ML are collaborating with Panasonic Inc., Japan. 30ABSTRACT Objective: Brain-computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here we provide a first meta-analysis evaluating the clinical effectiveness of BCI-based post-stroke motor rehabilitation. 5Methods: Trials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post-stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random-effects inverse variance method was used to calculate the summary effect size. Results:We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 10 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post-stroke survivors fulfilling the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta-analysis. Motor improvements, mostly quantified by the upper limb Fugl-Meyer Assessment (FMA-UE), exceeded the minimal clinical important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was 15 associated with a standardized mean difference (SMD) of 0.79 (95% CI: 0.37 to 1.20) in FMA-UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI-induced functional and structural neuroplasticity at a sub-clinical level. Interpretation:We found a medium to large effect size of BCI therapy compared to controls. This suggests that BCI technology might be an effective intervention for post-stroke upper limb rehabilitation. However, more studies with 20 larger sample size are required to increase the reliability of these results. 44 ) were considered for the meta-analysis. 1 https://www.ncbi.nlm.nih.gov/pubmed 2

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