Use of a Brain–Computer Interface + Exoskeleton Technology in Complex Multimodal Stimulation in the Rehabilitation of Stroke Patients

Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors

“…In the study by Faria et al (2018) with 22 patients, 90.90% suffered an ischemic stroke, 4.54% a hemorrhage stroke and 4.54% were not identified. In the study by Kotov et al (2020) with 23 patients, 91.30% had an ischemic stroke and 8.69% had a hemorrhagic stroke. The stroke type ratings were included in the studies by Prokopenko et al (2013) and Yeh et al (2019) .…”

“…Since the objectives of our review were to identify the effects of cognitive training in stroke patients aged 50 years or older, considering cognitive reserve proxies, also verifying whether clinical variables impacted these results, the studies included combined computerized cognitive training with other rehabilitation modalities, namely standard therapy ( Prokopenko et al, 2013 ; Kotov et al, 2020 ), conventional occupational therapy ( Faria et al, 2018 ) and training aerobic exercise ( Yeh et al, 2019 ).…”

“…Education ranged from 6 to 10 years of study. However, one study ( Kotov et al, 2020 ) did not describe the participants’ education in detail, as specified in Table 3 .…”

“…The studies used different types of computerized intervention as follows: (i) the Reh@Task, a multifunctional virtual reality tool for reaching upper limbs and cognitive training in different settings and rehabilitation paradigms, focused on neutral stimulus and traditionally used in standard rehabilitation—symbols, numbers and letters ( Faria et al, 2018 ); (ii) a complex multimodal stimulation program that included brain-computer neural interface technology with an arm exoskeleton used to reproduce de motion displayed in the images for the recovery of higher mental functions. Only this study used the computational tool in both groups ( Kotov et al, 2020 ); (iii) individual training with computer programs: an original method of restoring cognitive functions developed by the study group itself focusing on four aspects of attention (sustained, selective, safe and shifting) and based on a computerized version of Schulte’s Tables with biological feedback and the possibility of help ( Prokopenko et al, 2013 ); and (iv) the BrainHQ platform ( Posit Science, 2022 ): an online brain gym scientifically designed to train and improve the brain and its cognitive functions ( Yeh et al, 2019 ).…”

“…In the dimensions of randomization bias (D1), bias due to deviations from intended interventions (D2), bias due to lack of data in the results (D3), and bias due to outcome measurements (D4), all studies had a low risk of bias. In the assessment of bias due to the selection of the reported outcome (D5), two studies ( Faria et al, 2018 ; Yeh et al, 2019 ) maintained a low risk of bias and two ( Prokopenko et al, 2013 ; Kotov et al, 2020 ) were evaluated with some concerns.…”