Brain-Computer Interface Training With Functional Electrical Stimulation: Facilitating Changes in Interhemispheric Functional Connectivity and Motor Outcomes Post-stroke

Abstract

While most survivors of stroke experience some spontaneous recovery and receive treatment in the subacute setting, they are often left with persistent impairments in upper limb sensorimotor function which impact autonomy in daily life. Brain-Computer Interface (BCI) technology has shown promise as a form of rehabilitation that can facilitate motor recovery after stroke, however, we have a limited understanding of the changes in functional connectivity and behavioral outcomes associated with its use. Here, we investigate the effects of EEG-based BCI intervention with functional electrical stimulation (FES) on resting-state functional connectivity (rsFC) and motor outcomes in stroke recovery. 23 patients post-stroke with upper limb motor impairment completed BCI intervention with FES. Resting-state functional magnetic resonance imaging (rs-fMRI) scans and behavioral data were collected prior to intervention, post- and 1-month post-intervention. Changes in rsFC within the motor network and behavioral measures were investigated to identify brain-behavior correlations. At the group-level, there were significant increases in interhemispheric and network rsFC in the motor network after BCI intervention, and patients significantly improved on the Action Research Arm Test (ARAT) and SIS domains. Notably, changes in interhemispheric rsFC from pre- to both post- and 1 month post-intervention correlated with behavioral improvements across several motor-related domains. These findings suggest that BCI intervention with FES can facilitate interhemispheric connectivity changes and upper limb motor recovery in patients after stroke.

Aberrant interhemispheric functional reciprocities of the default mode network and motor network in subcortical ischemic stroke patients with motor impairment: A longitudinal study

“…The long-term training effect following robot-hand training was also detected in patients after stroke ( 23 ). A recent study on patients with stroke found that brain-computer interface technology could significantly improve interhemispheric FC in the motor network and motor outcomes poststroke ( 24 ). These previous studies implied that brain function recovery in patients with stroke is attributed to brain reorganization ( 25 ).…”

Advances in Stroke Recovery Therapeutics

“…Brain-computer interface devices measure neural signals with approaches ranging from precise implanted hardware to coarser noninvasive methods, and so control external devices in order to bypass injured neural pathways. A trial using 30 hours of electroencephalogram brain-computer interface-driven functional electric stimulation to paretic forearm muscles for chronic hemiparesis of broad severity 29 found significant gains in upper extremity function at 1 month that correlated with resting state interhemispheric connectivity increases.…”

Brain Computer Interface training for patients with severe upper limb paresis after stroke - A randomized controlled pilot trial

“…Still, improvements in UL motor function in patients in the chronic phase were signi cant and seemed to last after completing BCI-based therapy [16][17][18], though it can be debated if these improvements were clinically meaningful. In a recent study, BCI training combined with FES was found to increase resting state connectivity between the hemispheres and within the motor network, which correlated with improvements in UL motor function in chronic patients [19]. Other studies found a stronger desynchronization of alpha and beta bands in the ipsilesional hemisphere after BCI training [20,21].…”