Brain-controlled functional electrical stimulation therapy for gait rehabilitation after stroke: a safety study

Abstract

BackgroundMany 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.MethodsSubjects (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.ResultsNo 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.ConclusionBCI-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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-015-0050-4) contains supplementary material, which is available to authorized users.

Análise Comparativa Da Classicação De Sinais De Eletroencefalografia No Domínio Do Tempo Utilizando Redes PMC E RBF

“…Segundo [10,12] as referidas posições são propicias para identificar movimentos dos membros inferiores do lado direito do corpo do individuo. A Figura 1 ilustra a estrutura de aquisição fixada no individuo para os ensaios.…”

Interfacing brain with computer to improve communication and rehabilitation after brain damage

“…In this context, the possibility of integrating a BCI system with other technologies is invaluable (Belda-Lois et al, 2011;Ramos-Murguialday et al, 2013). We have mentioned the combination of BCIs with noninvasive brain stimulation techniques, such as tDCS (Ang et al, 2015); peripheral electrical stimulation in the form of functional electrical stimulation can also be controlled safely through the BCI for upper and lower limbs Daly et al, 2009;McCrimmon et al, 2015). BCIs and other technology-based strategies should be considered instruments in the hands of rehabilitation professionals (ie, therapists and medical doctors) and evaluated in light of the multifaceted and complex environment of current rehabilitation options for poststroke patients.…”

Common Spatial Pattern Apresenta 18% a Mais De Acurácia Que Laplaciano Em Imagética Motora De Membro Superior

“…Nos últimos anos, as interfaces cérebro-máquina (BCI, do inglês Brain Computer Interface) do tipo não invasiva tem se mostrado uma área de pesquisa de grande potencial para a reabilitação de indivíduos, aliando conceitos de neurociência, reabilitação física e engenharia biomédica [1][2][3][4]. Este desenvolvimento é justificado pelos avanços dos sistemas BCI's no que diz respeito à usabilidade, transferência de informações e robustez das técnicas de processamento de sinal e controle [5].…”