A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke

Abstract

Stroke is a leading cause of acquired disability resulting in distal upper extremity functional motor impairment. Stroke mortality rates continue to decline with advances in healthcare and medical technology. This has led to an increased demand for advanced, personalized rehabilitation. Survivors often experience some level of spontaneous recovery shortly after their stroke event; yet reach a functional plateau after which there is exiguous motor recovery. Nevertheless, studies have demonstrated the potential for recovery beyond this plateau. Non-traditional neurorehabilitation techniques, such as those incorporating the brain-computer interface (BCI), are being investigated for rehabilitation. BCIs may offer a gateway to the brain’s plasticity and revolutionize how humans interact with the world. Non-invasive BCIs work by closing the proprioceptive feedback loop with real-time, multi-sensory feedback allowing for volitional modulation of brain signals to assist hand function. BCI technology potentially promotes neuroplasticity and Hebbian-based motor recovery by rewarding cortical activity associated with sensory-motor rhythms through use with a variety of self-guided and assistive modalities.

Hemiparetic Stroke Rehabilitation Using Avatar and Electrical Stimulation Based on Non-invasive Brain Computer Interface

“…P1 had greater improvements in behavioural scales, and his classification accuracy was higher than P2's, which means that he received more concurrent sensory feedback with motor imagery task than P2. On the other hand, P2 did improve despite lower accuracy, and other work has shown that functional improvements are possible despite relatively low BCI accuracy [17]. Thus, high BCI accuracy could lead to greater functional improvement, but may not be required.…”

“…Their strokes were in the chronic phase when they started the training. They did not receive any other therapy during the intervention and fulfilled the following inclusion criteria: (1) ability to understand written and spoken instructions from therapists; (2) hemiparesis; (3) time since stroke of at least 4 days; (4) stable neurological status other than stroke; (5) ability to participate in the study for 3 month; (6) no pregnancy; (7) no implanted medical devices such as pacemakers; (8) no implanted metallic fragments in the upper extremities; (9) no cerebellar lesion; (10) no severe hemi-neglect; (11) no epilepsy; (12) no fractures or lesions in the upper extremities; (13) no severe lung diseases or liver disease; (14) no severe pusher syndrome; (15) ability to maintain a seated position for one hour; (16) no sensory disorder feeling pain or unsuitably reacting to sensory stimuli; (17) no peripheral nervous diseases affecting the upper limbs (brachial plexus pals and cervical radicular syndromes).…”

Brain-machine Interface in Robot-assisted Neurorehabilitation for Patients with Stroke and Upper Extremity Weakness – the Therapeutic Turning Point

“…As the brain naturally seeks hedonia, it can be beneficial for deeper emersion to the therapy that BMIs give the patient more immediate feedback [55]. especially as positive feedback.…”

Dreaming of the future of stroke: translation of bench to bed

“…Because BCI can substitute physical impairments such as motor and language functions, it enables patients with stroke who exhibit motor impairments to control the electrical device, which could be a computer cursor and a wheelchair [42]. Furthermore, BCI has been applied for motor neuromodulation purposes to induce real-time feedback to patients with stroke and to reward consistent production of neural features concordant with the motor function [41,43].…”

“…Brain-computer interfaces (BCIs) can connect a human brain and an external device without the need for human sensory and motor system [41]. Because BCI can substitute physical impairments such as motor and language functions, it enables patients with stroke who exhibit motor impairments to control the electrical device, which could be a computer cursor and a wheelchair [42].…”