Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

Abstract

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.

Efficacy of Brain–Computer Interface and the Impact of Its Design Characteristics on Poststroke Upper-limb Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…26 Our meta-analysis studied changes in the FMA-UE scores between pre and postintervention, and showed that BCI had a significantly higher effect size in improving upper extremity functions following stroke, when compared with control therapies. These findings are consistent with the results of the previous meta-analysis, 24 and support the short-term efficacy of BCI. Importantly, our study analyzed 12 randomized controlled trials involving 298 stroke patients, while the previous study 24 covered 9 randomized controlled trials with 235 stroke patients.…”

“…These findings are consistent with the results of the previous meta-analysis, 24 and support the short-term efficacy of BCI. Importantly, our study analyzed 12 randomized controlled trials involving 298 stroke patients, while the previous study 24 covered 9 randomized controlled trials with 235 stroke patients.…”

Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study

“…In terms of clinical scale scores (FMA-UE, WMFT, and MBI score), upper limb motor functional improvement was observed in both groups after 2-week intervention. This result is consistent with previous evidence demonstrating the effectiveness of BCI intervention for stroke patients’ UL motor function recovery ( Cervera et al, 2018 ; Wu et al, 2020 ) and a randomized controlled multicenter trial with post-stroke patients (in subacute and chronic phase), which showed significant improvements of FMA-UE scores in BCI and control group ( Frolov et al, 2017 ). The clinical scale scores of the BG had a significantly greater motor function improvement than the CG at the follow-up week rather than Week 2.…”

Brain Computer Interface Treatment for Motor Rehabilitation of Upper Extremity of Stroke Patients—A Feasibility Study

“…Patients in the chronic stage could improve motor function in the paretic side, which is not commonly accepted. These results support other work indicating that a BCI can play an important role in cortical reorganization that underlies functional improvement (Dobkin, 2007;Biasiucci et al, 2018;Cervera et al, 2018). The improvements experienced by the BCItreatment are due to neuroplastic changes in the central nervous system caused by closed-loop learning (Wolpaw, 2007;Biasiucci et al, 2018;Cervera et al, 2018), rather than improvements due to the effects of muscle electrostimulation that disappear over time.…”

“…These results support other work indicating that a BCI can play an important role in cortical reorganization that underlies functional improvement (Dobkin, 2007;Biasiucci et al, 2018;Cervera et al, 2018). The improvements experienced by the BCItreatment are due to neuroplastic changes in the central nervous system caused by closed-loop learning (Wolpaw, 2007;Biasiucci et al, 2018;Cervera et al, 2018), rather than improvements due to the effects of muscle electrostimulation that disappear over time. The long-lasting effects of the FES treatment alone are under discussion (Howlett et al, 2015;Eraifej et al, 2017), but the real-time synchronization of MI, immersive avatar therapy and electrical stimulation could be a powerful combination to bolster Hebbian plasticity underlying recovery.…”