KITE-BCI: A brain-computer interface system for functional electrical stimulation therapy

Abstract

Context/Objective Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI). Despite promising results, the combined use of these technologies (BCI-FEST) in clinical practice is minimal. To address this issue, we developed KITE-BCI, a BCI system specifically designed for clinical application and integration with dynamic FEST. In this paper, we report its technical features and performance. In addition, we discuss the differences in distributions of the BCI- and therapist-triggered stimulation latencies. Design Two single-arm 40-session interventional studies to test the feasibility of BCI-controlled FEST for upper limb motor rehabilitation in individuals with cervical SCI Setting Rehabilitation programs within the University and Lyndhurst Centres of the Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Participants Five individuals with sub-acute (< 6 months post-injury) SCI at the C4-C5 level, AIS B-D, and three individuals with chronic (> 24 months post-injury) SCI at C4 level, AIS B-C. Outcome Measures We measured BCI setup duration, and to characterize the performance of KITE-BCI, we recorded BCI sensitivity, defined as the percentage of successful BCI activations out of the total number of cued movements. Results The overall BCI sensitivities were 74.46% and 79.08% for the sub-acute and chronic groups, respectively. The average KITE-BCI setup duration across the two studies was 11 min and 13 s. Conclusion KITE-BCI demonstrates a clinically viable single-channel BCI system for integration with FEST resulting in a versatile technology-enhanced upper limb motor rehabilitation strategy after SCI.

Effectiveness of motor and prefrontal cortical areas for brain-controlled functional electrical stimulation neuromodulation

“…The faster BCI detection possibly contributed to the closer timing between associative pre and postsynaptic activations, resulting in more effective M1 intervention effects. This is consistent with a study suggesting that the shorter timing between the movement-related cortical activity and FES-induced feedback plays a critical role in the superior neuromodulation effectiveness of BCI-FES therapy compared to therapist-triggered FES therapy [48]. Evidence from paired-associative stimulation studies also highlights the importance of the millisecond range temporal sequencing of the associative activation of cortical networks and FES, which follows spike timing-dependent plasticity (STDP) [16,49,50].…”

Therapists’ perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

“…Unfortunately, there is little understanding of the neurophysiological mechanisms behind these devices. The device setup [ 12 , 19 ] and feasibility [ 6 , 13 , 22 , 39 – 42 ] have been documented in research to inform educational content. Ultimately, as research aggregates, educational content of training courses, or CoP resources, for example, should be updated.…”

“…An analysis of the physical opportunity to provide BCI-FEST clinically reveals that training and restructuring the environment to provide cues and prompts can address time barriers and other physical barriers [ 23 , 32 ]. Despite an average system setup time of 11 min and 13 s for studies that our therapists participated in [ 19 ], they desired to decrease this time further. However, with practice research has shown that donning times significantly decrease [ 16 ].…”

“…Activation of the BCI also controls the execution of the stimulation program. Details of the system, which was specifically developed to support delivery of FES therapy, are available elsewhere [ 19 ].…”