Case report: post-stroke interventional BCI rehabilitation in an individual with preexisting sensorineural disability

Abstract

Therapies involving new technologies such as brain-computer interfaces (BCI) are being studied to determine their potential for interventional rehabilitation after acute events such as stroke produce lasting impairments. While studies have examined the use of BCI devices by individuals with disabilities, many such devices are intended to address a specific limitation and have been studied when this limitation or disability is present in isolation. Little is known about the therapeutic potential of these devices for individuals with multiple disabilities with an acquired impairment overlaid on a secondary long-standing disability. We describe a case in which a male patient with congenital deafness suffered a right pontine ischemic stroke, resulting in persistent weakness of his left hand and arm. This patient volunteer completed four baseline assessments beginning at 4 months after stroke onset and subsequently underwent 6 weeks of interventional rehabilitation therapy using a closed-loop neurofeedback BCI device with visual, functional electrical stimulation, and tongue stimulation feedback modalities. Additional assessments were conducted at the midpoint of therapy, upon completion of therapy, and 1 month after completing all BCI therapy. Anatomical and functional MRI scans were obtained at each assessment, along with behavioral measures including the Stroke Impact Scale (SIS) and the Action Research Arm Test (ARAT). Clinically significant improvements in behavioral measures were noted over the course of BCI therapy, with more than 10 point gains in both the ARAT scores and scores for the SIS hand function domain. Neuroimaging during finger tapping of the impaired hand also showed changes in brain activation patterns associated with BCI therapy. This case study demonstrates the potential for individuals who have preexisting disability or possible atypical brain organization to learn to use a BCI system that may confer some rehabilitative benefit.

BCI-FES: could a new rehabilitation device hold fresh promise for stroke patients?

“…Feedback modalities that have been incorporated into BCI devices include visual displays [5,11], FES [12], robot-assisted movement [13], and cranial nerve noninvasive neuromodulation [14]. When using BCI devices to facilitate motor rehabilitation, this feedback is often controlled using desynchronization of the Mu and Beta rhythms detected over the sensorimotor cortex [4,5,11,12,15]. …”

“…The use of BCI devices to target and train the modulation of neural activity during rehabilitative therapy may then encourage neuroplastic changes associated with improved functional gains and facilitate additional motor recovery. Currently, BCI technology is being incorporated into new devices intended to facilitate additional rehabilitation in stroke survivors with persistent motor impairments [5,12,15,18]. …”

Rehabilitation of hand in subacute tetraplegic patients based on brain computer interface and functional electrical stimulation: a randomised pilot study

“…We applied a BCI algorithm based on time domain parameters with an on-line adaptation (Vidaurre et al 2009), which allows the brief update of training parameters and requires smaller number of electrodes than what is required for algorithms based on common spatial patterns (16-63 electrodes Fei et al 2008, Li et al 2014. Six EEG electrodes (3 bipolar recordings) used in this study is a comparable number with the number of electrodes required for algorithms based on classical EEG bandpower and features extracted from a specific frequency bands (2-12 electrodes Tam et al 2011, Mukaino et al 2014, Young et al 2014, Vučković et al 2015.…”

“…BCIs controlled FES has two main applications for neurologically injured patients: to restore the lost function as an assistive device for a long term use (Pfurtscheller et al 2003) or to improve a partially preserved function. In the latter case, BCI-FES is used as a rehabilitative device on a short-term basis (Fei et al 2008, Daly et al 2009, Tan et al 2011, Tam et al 2011, Li et al 2014, Mukaino et al 2014, Young et al 2014.…”

Interaction of BCI with the underlying neurological conditions in patients: pros and cons

“…Stroke remains the most frequently tested patient population. In a randomized controlled trial on 21 chronic stroke patients, Ang et al compare An interesting case study by Young et al (2014a), which fits well with the topic of the special issue, investigated how the preexisting neurological condition (congenital deafness) of a stroke patient influences performance of BCI system used for motor rehabilitation. The same research group provided a comprehensive analysis on the influence of BCI training on functional brain connectivity and brain organization, as measured by EEG and fMRI and it's relation to motor gains (Song et al, 2014;Young et al, 2014b,c).…”