On the way home: a BCI-FES hand therapy self-managed by sub-acute SCI participants and their caregivers: a usability study

Abstract

Background Regaining hand function is the top priority for people with tetraplegia, however access to specialised therapy outwith clinics is limited. Here we present a system for hand therapy based on brain-computer interface (BCI) which uses a consumer grade electroencephalography (EEG) device combined with functional electrical stimulation (FES), and evaluate its usability among occupational therapists (OTs) and people with spinal cord injury (SCI) and their family members. Methods Users: Eight people with sub-acute SCI (6 M, 2F, age 55.4 ± 15.6) and their caregivers (3 M, 5F, age 45.3 ± 14.3); four OTs (4F, age 42.3 ± 9.8). User Activity: Researchers trained OTs; OTs subsequently taught caregivers to set up the system for the people with SCI to perform hand therapy. Hand therapy consisted of attempted movement (AM) of one hand to lower the power of EEG sensory-motor rhythm in the 8-12 Hz band and thereby activate FES which induced wrist flexion and extension. Technology: Consumer grade wearable EEG, multichannel FES, custom made BCI application. Location: Research space within hospital. Evaluation: donning times, BCI accuracy, BCI and FES parameter repeatability, questionnaires, focus groups and interviews. Results Effectiveness: The BCI accuracy was 70–90%. Efficiency: Median donning times decreased from 40.5 min for initial session to 27 min during last training session (N = 7), dropping to 14 min on the last self-managed session (N = 3). BCI and FES parameters were stable from session to session. Satisfaction: Mean satisfaction with the system among SCI users and caregivers was 3.68 ± 0.81 (max 5) as measured by QUEST questionnaire. Main facilitators for implementing BCI-FES technology were “seeing hand moving”, “doing something useful for the loved ones”, good level of computer literacy (people with SCI and caregivers), “active engagement in therapy” (OT), while main barriers were technical complexity of setup (all groups) and “lack of clinical evidence” (OT). Conclusion BCI-FES has potential to be used as at home hand therapy by people with SCI or stroke, provided it is easy to use and support is provided. Transfer of knowledge of operating BCI is possible from researchers to therapists to users and caregivers. Trial registration Registered with NHS GG&C on December 6th 2017; clinicaltrials.gov reference number NCT03257982, url: https://clinicaltrials.gov/ct2/show/NCT03257982.

Application of a Brain–Computer Interface System with Visual and Motor Feedback in Limb and Brain Functional Rehabilitation after Stroke: Case Report

“…In this study, we undertook preliminary clinical experiments to investigate the feasibility, safety, and potential rehabilitation efficacy for restoring limb and brain functions of hemiplegic stroke patients using the new BCI system. This system differs from the traditional active/passive rehabilitation training mode with respect to the multichannel feedback, and adopts the active rehabilitation training mode of bidirectional synchronous stimulation of the central and peripheral nervous systems [ 13 , 14 ]. Using this system requires patients to actively participate in the whole process and focus on their training done through motor imagery.…”

“…With the help of BCI technology, patients can actively participate in rehabilitation training. BCI has been reported for the rehabilitation of stroke and similar disorders like Parkinson’s disease, cerebral palsy, and spinal cord injury, and can significantly promote the recovery of limb function in these patients [ 13 , 14 , 15 , 16 ]. However, how to get stroke patients to imagine target tasks more effectively and stably; how to monitor the performance of imaginary tasks; how to accurately capture and identify task-related EEG signals; how to convert EEG signals into views, movements, sounds, etc., in order to achieve the enhanced efficacy of BCI training with multiple sensory feedback; and how to solve BCI training fatigue to ensure effective training time are still challenges [ 17 ].…”

Design-development of an at-home modular brain–computer interface (BCI) platform in a case study of cervical spinal cord injury

“…This setup avoids the use of EEG caps that might require wire connections, gel application, accurate placement, and configuration of the EEG cap [ 66 , 67 ]. In comparison, a recent study was able to achieve an average setup time of 20 min in 8 caretaker-subject pairs over several sessions [ 68 ]. In general, setup times are dependent on the setup time of each component of a BCI system.…”

“…Like many invasive studies, our implementation of an invasive device is limited to one subject, and thus difficult to generalize. Fortunately, using event-related desynchronizations as a method to perform binary classification of motor imagery is well established [ 68 , 71 – 74 ], and a few studies have employed it in the home [ 34 , 68 , 75 , 76 ]. Although, we employed this BCI system for use in a subject with cervical SCI, it has provided insights in to limitations how the software and App can be improved for easier incorporation into other BCI implementations.…”

A Residual Movement Classification Based User Interface for Control of Assistive Devices by Persons With Complete Tetraplegia

“…Recently, brain computer interfaces (BCI) research has gained momentum. BCIs are attractive because they aim at restoring motor control in a very similar way as it was before the injury [9]- [11]. Nevertheless, current BCIs still lack the accuracy needed for upper limb control [12], [13].…”