Brain-Computer Interfaces for Post-Stroke Motor Rehabilitation: A Meta-Analysis

Abstract

GG were employees of MindMaze SA, Switzerland and NB was an employee of Wyss Center, Switzerland. JU and ML are collaborating with Panasonic Inc., Japan. 30ABSTRACT Objective: 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. 5Methods: 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. Results:We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 10 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 fulfilling 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 clinical important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was 15 associated with a standardized mean difference (SMD) 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 sub-clinical level. Interpretation:We found a medium to large effect size of BCI therapy compared to controls. This suggests that BCI technology might be an effective intervention for post-stroke upper limb rehabilitation. However, more studies with 20 larger sample size are required to increase the reliability of these results. 44 ) were considered for the meta-analysis. 1 https://www.ncbi.nlm.nih.gov/pubmed 2

Brain‐machine interface of upper limb recovery in stroke patients rehabilitation: A systematic review

“…Regarding visual feedback, the one used in the present review is predominantly abstract (e.g., the cue on a computer screen can be an arrow), contrary to others that have included realistic visual feedback (e.g., visual hand representation of an actor's perspective; Cervera et al, ; Cincotti et al, ; Neuper, Scherer, Wriessnegger, & Pfurtscheller, ; Ono et al, ; Pichiorri et al, ). Realistic feedback, such as a virtual hand movement, might be preferable to more abstract feedback, given the possibility that its observation may itself lead to an activation of mirror neuron in the sensorimotor areas (Lucca, ; Pfurtscheller, Muller‐Putz, Scherer, & Neuper, ).…”

“…This systematic review included nine studies with high quality research showing some benefits of BCI in upper limb recovery, which consequently remained after intervention. Similarly, a recent meta‐analysis mentioned that the standardized difference in means of mean change in the FMA between the experimental and the control groups favours BCI therapy in eight out of nine studies despite the heterogeneity (Cervera et al, ). Besides those mentioned, several other studies with similar purposes have been conducted in stroke patients (Buch et al, ; Caria et al, ; Prasad, Herman, Coyle, McDonough, & Crosbie, ; Varkuti et al, ) and depicted some interesting findings.…”

“…The authors interpreted these findings by suggesting that BCI training strengthens neuroplasticity, leading to a better recovery, because MI through BCI involves the same neural mechanisms that control voluntary movement of the hand (Remsik et al, ). Several neuroplasticity changes due to BCI such as increasing premotor area activity or enhancement of ipsilesional connectivity with changes in hemispheric EEG activity were mentioned (see Cervera et al, ). However, care must be considered because of the small sample size.…”

Minimizing biosignal recording sites for hybrid noninvasive brain/neural robot control

“…SRS received special support by the Brain & Behavior Research Foundation as 2017 NARSAD Young Investigator Grant recipient and P&S Fund Investigator. Alessia Cavallo, Vincent Roth, David Haslacher, Marius Nann and Surjo Soekadar are with the Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ), Department of Psychiatry and Psychotherapy, recovery when used repeatedly [5][6] [7]. This rehabilitative approach substantially extends the clinical relevance of braincontrolled devices, because approximately one in three stroke survivors suffers from severe motor impairments for which no other treatment strategy exists [8].…”

Electrical, Hemodynamic, and Motor Activity in BCI Post-stroke Rehabilitation: Clinical Case Study

“…The methods of post-stroke rehabilitation using the limb exoskeleton controlled by brain-computer interface (BCI) based on kinesthetic motor imagery (MI) may be helpful for the motor function recovery (1). The procedure efficiency has been shown by several randomized controlled studies (2–8).…”