Active Physical Practice Followed by Mental Practice Using BCI-Driven Hand Exoskeleton: A Pilot Trial for Clinical Effectiveness and Usability

Abstract

Appropriately combining mental practice (MP) and physical practice (PP) in a poststroke rehabilitation is critical for ensuring a substantially positive rehabilitation outcome. Here, we present a rehabilitation protocol incorporating a separate active PP stage followed by MP stage, using a hand exoskeleton and brain-computer interface (BCI). The PP stage was mediated by a force sensor feedback-based assist-as-needed control strategy, whereas the MP stage provided BCI-based multimodal neurofeedback combining anthropomorphic visual feedback and proprioceptive feedback of the impaired hand extension attempt. A six week long clinical trial was conducted on four hemiparetic stroke patients (screened out of 16) with a left-hand disability. The primary outcome, motor functional recovery, was measured in terms of changes in grip-strength (GS) and action research arm test (ARAT) scores; whereas the secondary outcome, usability of the system was measured in terms of changes in mood, fatigue, and motivation on a visual-analog-scale. A positive rehabilitative outcome was found as the group mean changes from the baseline in the GS and ARAT were +6.38 kg and +5.66 accordingly. The VAS scale measurements also showed betterment in mood ( 1.38), increased motivation (+2.10) and reduced fatigue (0.98) as compared to the baseline. Thus, the proposed neurorehabilitation protocol is found to be promising both in terms of clinical effectiveness and usability.

Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis

“…A total of 1015 records were screened, of which the full texts of 80 were assessed for eligibility. Finally, 33 studies were included in the current systematic review [6, 7, 15-17, 26, 35, 37, 46, 47, 49-71], of which 18 studies were of single-group design [26,37,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71], and 15 studies were of controlled-trial design [6, 7, 15-17, 35, 46, 47, 49-55]. In the current review, only studies with a controlled-trial design were included in our metaanalysis, and those with single-group designs were only included in our qualitative description.…”

“…In particular, the average duration since stroke onset indicated that the subjects were at chronic stages, and so improvements in motor function were less likely to be caused by spontaneous recovery. In those single-group studies in which statistical analysis had not been performed, most likely due to the small sample size, descriptive statistics indicated that the majority of subjects benefited from the BCI treatment [26,37,58,60,62,65,69]. However, Buch et al [56] found that six out of eight subjects could volitionally control the BCI system via the ERD of the mu rhythm, whereas there was no significant improvement in residual finger extension, as measured by the Medical Research Council Scale, after 13 to 22 training sessions.…”

Evaluation of haptic guidance virtual fixtures and 3D visualization methods in telemanipulation—a user study

“…In the case where depth perception is difficult, avoiding contacts and maintaining a safe, desired path can be assisted with such virtual fixtures. Vision and haptic virtual fixtures have been used in tandem for novel clinical applications as well [7,8].…”

An EEG-EMG correlation-based brain-computer interface for hand orthosis supported neuro-rehabilitation

“…These include switching or controlling different neuro-prosthetic devices, wheelchairs, and exoskeletons for therapeutic or daily living activities [2]. Some of these rehabilitative settings are based on brain signals such as electroencephalogram (EEG) or magnetoencephalogram (MEG) [3,4,5,6,7,8,9], while some others depend on biosignals such as electromyogram (EMG) [10,11]. Using brain or muscle signals alone for the actuation and control of external devices poses their own challenges.…”