Neural Interface-Based Motor Neuroprosthesis in Poststroke Upper Limb Neurorehabilitation: An Individual Patient Data Meta-analysis

OBJECTIVE

To determine the efficacy of neural interface-based neurorehabilitation, including brain-computer interface, through conventional and individual patient data (IPD) meta-analysis and to assess clinical parameters associated with positive response to neural interface-based neurorehabilitation.

DATA SOURCES

PubMed, EMBASE, and Cochrane Library databases up to February 2022 were reviewed.

STUDY SELECTION

Studies using neural interface-controlled physical effectors (functional electrical stimulation and/or powered exoskeletons) and reported Fugl-Meyer Assessment-upper-extremity (FMA-UE) scores were identified. This meta-analysis was prospectively registered on PROSPERO (#CRD42022312428). PRISMA guidelines were followed.

DATA EXTRACTION

Changes in FMA-UE scores were pooled to estimate the mean effect size. Subgroup analyses were performed on clinical parameters and neural interface parameters with both study-level variables and IPD.

DATA SYNTHESIS

Forty-six studies containing 617 patients were included. Twenty-nine studies involving 214 patients reported IPD. FMA-UE scores increased by a mean of 5.23 (95% confidence interval [CI]: 3.85-6.61). Systems that used motor attempt resulted in greater FMA-UE gain than motor imagery, as did training lasting >4 vs ≤4 weeks. On IPD analysis, the mean time-to-improvement above minimal clinically important difference (MCID) was 12 weeks (95% CI: 7 to not reached). At 6 months, 58% improved above MCID (95% CI: 41%-70%). Patients with severe impairment (P=.042) and age >50 years (P=.0022) correlated with the failure to improve above the MCID on univariate log-rank tests. However, these factors were only borderline significant on multivariate Cox analysis (hazard ratio [HR] 0.15, P=.08 and HR 0.47, P=.06, respectively).

CONCLUSION

Neural interface-based motor rehabilitation resulted in significant, although modest, reductions in poststroke impairment and should be considered for wider applications in stroke neurorehabilitation.

The clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation: a meta-analysis and systematic review

PURPOSE

Many recent clinical studies have suggested that the combination of brain-computer interfaces (BCIs) can induce neurological recovery and improvement in motor function. In this review, we performed a systematic review and meta-analysis to evaluate the clinical effects of BCI-robot systems.

METHODS

The articles published from January 2010 to December 2020 have been searched by using the databases (EMBASE, PubMed, CINAHL, EBSCO, Web of Science and manual search). The single-group studies were qualitatively described, and only the controlled-trial studies were included for the meta-analysis. The mean difference (MD) of Fugl-Meyer Assessment (FMA) scores were pooled and the random-effects model method was used to perform the meta-analysis. The PRISMA criteria were followed in current review.

RESULTS

A total of 897 records were identified, eight single-group studies and 11 controlled-trial studies were included in our review. The systematic analysis indicated that the BCI-robot systems had a significant improvement on motor function recovery. The meta-analysis showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects (p > 0.05).

CONCLUSION

The use of BCI-robot systems has significant improvement on the motor function recovery of hemiparetic upper-limb, and there is a sustaining effect. The meta-analysis showed no statistical difference between the experimental group (BCI-robot) and the control group (robot). However, there are a few shortcomings in the experimental design of existing studies, more clinical trials need to be conducted, and the experimental design needs to be more rigorous.Implications for RehabilitationIn this review, we evaluated the clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation. After we screened the databases, 19 articles were included in this review. These articles all clinical trial research, they all used non-invasive brain-computer interfaces and upper-limb robot.We conducted the systematic review with nine articles, the result indicated that the BCI-robot system had a significant improvement on motor function recovery. Eleven articles were included for the meta-analysis, the result showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects.We thought the result of meta-analysis which showed no statistic difference was probably caused by the heterogenicity of clinical trial designs of these articles.We thought the BCI-robot systems are promising strategies for post-stroke rehabilitation. And we gave several suggestions for further research: (1) The experimental design should be more rigorous, and describe the experimental designs in detail, especially the control group intervention, to make the experiment replicability. (2) New evaluation criteria need to be established, more objective assessment such as biomechanical assessment, fMRI should be utilised as the primary outcome. (3) More clinical studies with larger sample size, novel external devices, and BCI systems need to be conducted to investigate the differences between BCI-robot system and other interventions. (4) Further research could shift the focus to the patients who are in subacute stage, to explore if the early BCI training can make a positive impact on cerebral cortical recovery.

Relationship between resting-state functional connectivity and change in motor function after motor imagery intervention in patients with stroke: a scoping review

BACKGROUND

In clinical practice, motor imagery has been proposed as a treatment modality for stroke owing to its feasibility in patients with severe motor impairment. Motor imagery-based interventions can be categorized as open- or closed-loop. Closed-loop intervention is based on voluntary motor imagery and induced peripheral sensory afferent (e.g., Brain Computer Interface (BCI)-based interventions). Meanwhile, open-loop interventions include methods without voluntary motor imagery or sensory afferent. Resting-state functional connectivity (rs-FC) is defined as a significant temporal correlated signal among functionally related brain regions without any stimulus. rs-FC is a powerful tool for exploring the baseline characteristics of brain connectivity. Previous studies reported changes in rs-FC after motor imagery interventions. Systematic reviews also reported the effects of motor imagery-based interventions at the behavioral level. This study aimed to review and describe the relationship between the improvement in motor function and changes in rs-FC after motor imagery in patients with stroke.

REVIEW PROCESS

The literature review was based on Arksey and O'Malley's framework. PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science were searched up to September 30, 2023. The included studies covered the following topics: illusion without voluntary action, motor imagery, action imitation, and BCI-based interventions. The correlation between rs-FC and motor function before and after the intervention was analyzed. After screening by two independent researchers, 13 studies on BCI-based intervention, motor imagery intervention, and kinesthetic illusion induced by visual stimulation therapy were included.

CONCLUSION

All studies relating to motor imagery in this review reported improvement in motor function post-intervention. Furthermore, all those studies demonstrated a significant relationship between the change in motor function and rs-FC (e.g., sensorimotor network and parietal cortex).

The role of brain oscillations in post-stroke motor recovery: An overview

Stroke is the second cause of disability and death worldwide, highly impacting patient’s quality of life. Several changes in brain architecture and function led by stroke can be disclosed by neurophysiological techniques. Specifically, electroencephalogram (EEG) can disclose brain oscillatory rhythms, which can be considered as a possible outcome measure for stroke recovery, and potentially shaped by neuromodulation techniques. We performed a review of randomized controlled trials on the role of brain oscillations in patients with post-stroke searching the following databases: Pubmed, Scopus, and the Web of Science, from 2012 to 2022. Thirteen studies involving 346 patients in total were included. Patients in the control groups received various treatments (sham or different stimulation modalities) in different post-stroke phases. This review describes the state of the art in the existing randomized controlled trials evaluating post-stroke motor function recovery after conventional rehabilitation treatment associated with neuromodulation techniques. Moreover, the role of brain pattern rhythms to modulate cortical excitability has been analyzed. To date, neuromodulation approaches could be considered a valid tool to improve stroke rehabilitation outcomes, despite more high-quality, and homogeneous randomized clinical trials are needed to determine to which extent motor functional impairment after stroke can be improved by neuromodulation approaches and which one could provide better functional outcomes. However, the high reproducibility of brain oscillatory rhythms could be considered a promising predictive outcome measure applicable to evaluate patients with stroke recovery after rehabilitation.

Motor Impairment in Stroke Patients is Associated with Network Properties During Consecutive Motor Imagery

OBJECTIVE

Our study aimed to predict the Fugl-Meyer assessment (FMA) upper limb using network properties during motor imagery using electroencephalography (EEG) signals.

METHODS

The subjects performed a finger tapping imagery task according to consecutive cues. We measured the weighted phase lag index (wPLI) as functional connectivity and directed transfer function (DTF) as causal connectivity in healthy controls and stroke patients. The network properties based on the wPLI and DTF were calculated. We predicted the FMA upper limb using partial least squares regression.

RESULTS

A higher DTF in the mu band was observed in stroke patients than in healthy controls. Notably, the difference in local properties at node F3 was negatively correlated with motor impairment in stroke patients. Finally, using significant network properties based on the wPLI and DTF, we predicted motor impairments using the FMA upper limb with a root-mean-square error of 1.68 (R² = 0.97). This outperformed the state-of-the-art predictors.

CONCLUSION

These findings demonstrate that network properties based on functional and causal connectivity were highly associated with motor function in stroke patients.

SIGNIFICANCE

Our network properties can help calculate the predictor of motor impairments in stroke rehabilitation and provide insight into the neural correlates related to motor function based on EEG after reorganization induced by stroke.

EEG characteristic investigation of the sixth-finger motor imagery and optimal channel selection for classification

OBJECTIVE

Supernumerary Robotic Limbs (SRL) are body augmentation robotic devices by adding extra limbs or fingers to the human body different from the traditional wearable robotic devices such as prosthesis and exoskeleton. We proposed a novel MI (Motor imagery)-based BCI paradigm based on the sixth-finger which imagines controlling the extra finger movements. The goal of this work is to investigate the EEG characteristics and the application potential of MI-based BCI systems based on the new imagination paradigm (the sixth finger MI).

APPROACH

14 subjects participated in the experiment involving the sixth finger MI tasks and rest state. Event-related spectral perturbation (ERSP) was adopted to analyse EEG spatial features and key-channel time-frequency features. Common spatial patterns (CSP) were used for feature extraction and classification was implemented by support vector machine (SVM). A genetic algorithm (GA) was used to select combinations of EEG channels that maximized classification accuracy and verified EEG patterns based on the sixth finger MI. And we conducted a longitudinal 4-week EEG control experiment based on the new paradigm.

MAIN RESULTS

ERD (event-related desynchronization) was found in the supplementary motor area (SMA) and primary motor area (M1) with a faint contralateral dominance. Unlike traditional MI based on the human hand, ERD was also found in frontal lobe. GA results showed that the distribution of the optimal 8-channel is similar to EEG topographical distributions, nearing parietal and frontal lobe. And the classification accuracy based on the optimal 8-channel (the highest accuracy of 80% and mean accuracy of 70%) was significantly better than that based on the random 8-channel (p<0.01).

SIGNIFICANCE

This work provided a new paradigm for MI-based MI system and verified its feasibility, widened the control bandwidth of the BCI system.

Neural Decoding of Chinese Sign Language With Machine Learning for Brain-Computer Interfaces

Limb motion decoding is an important part of brain-computer interface (BCI) research. Among the limb motion, sign language not only contains rich semantic information and abundant maneuverable actions but also provides different executable commands. However, many researchers focus on decoding the gross motor skills, such as the decoding of ordinary motor imagery or simple upper limb movements. Here we explored the neural features and decoding of Chinese sign language from electroencephalograph (EEG) signal with motor imagery and motor execution. Sign language not only contains rich semantic information, but also has abundant maneuverable actions, and provides us with more different executable commands. In this paper, twenty subjects were instructed to perform movement execution and movement imagery based on Chinese sign language. Seven classifiers are employed to classify the selected features of sign language EEG. L1 regularization is used to learn and select features that contain more information from the mean, power spectral density, sample entropy, and brain network connectivity. The best average classification accuracy of the classifier is 89.90% (imagery sign language is 83.40%). These results have shown the feasibility of decoding between different sign languages. The source location reveals that the neural circuits involved in sign language are related to the visual contact area and the pre-movement area. Experimental evaluation shows that the proposed decoding strategy based on sign language can obtain outstanding classification results, which provides a certain reference value for the subsequent research of limb decoding based on sign language.

The Differences Between Motor Attempt and Motor Imagery in Brain-Computer Interface Accuracy and Event-Related Desynchronization of Patients With Hemiplegia

Background: Motor attempt and motor imagery (MI) are two common motor tasks used in brain-computer interface (BCI). They are widely researched for motor rehabilitation in patients with hemiplegia. The differences between the motor attempt (MA) and MI tasks of patients with hemiplegia can be used to promote BCI application. This study aimed to explore the accuracy of BCI and event-related desynchronization (ERD) between the two tasks.

Materials and Methods: We recruited 13 patients with stroke and 3 patients with traumatic brain injury, to perform MA and MI tasks in a self-control design. The BCI accuracies from the bilateral, ipsilesional, and contralesional hemispheres were analyzed and compared between different tasks. The cortical activation patterns were evaluated with ERD and laterality index (LI).

Results: The study showed that the BCI accuracies of MA were significantly (p < 0.05) higher than MI in the bilateral, ipsilesional, and contralesional hemispheres in the alpha-beta (8–30 Hz) frequency bands. There was no significant difference in ERD and LI between the MA and MI tasks in the 8–30 Hz frequency bands. However, in the MA task, there was a negative correlation between the ERD values in the channel CP1 and ipsilesional hemispheric BCI accuracies (r = −0.552, p = 0.041, n = 14) and a negative correlation between the ERD values in channel CP2 and bilateral hemispheric BCI accuracies (r = −0.543, p = 0.045, n = 14). While in the MI task, there were negative correlations between the ERD values in channel C4 and bilateral hemispheric BCI accuracies (r = −0.582, p = 0.029, n = 14) as well as the contralesional hemispheric BCI accuracies (r = −0.657, p = 0.011, n = 14). As for motor dysfunction, there was a significant positive correlation between the ipsilesional BCI accuracies and FMA scores of the hand part in 8–13 Hz (r = 0.565, p = 0.035, n = 14) in the MA task and a significant positive correlation between the ipsilesional BCI accuracies and FMA scores of the hand part in 13–30 Hz (r = 0.558, p = 0.038, n = 14) in the MI task.

Conclusion: The MA task may achieve better BCI accuracy but have similar cortical activations with the MI task. Cortical activation (ERD) may influence the BCI accuracy, which should be carefully considered in the BCI motor rehabilitation of patients with hemiplegia.

Transfer Learning based on Optimal Transport for Motor Imagery Brain-Computer Interfaces

OBJECTIVE

This paper tackles the cross-sessions variability of electroencephalography-based brain-computer interfaces (BCIs) in order to avoid the lengthy recalibration step of the decoding method before every use.

METHODS

We develop a new approach of domain adaptation based on optimal transport to tackle brain signal variability between sessions of motor imagery BCIs. We propose a backward method where, unlike the original formulation, the data from a new session are transported to a calibration session, and thereby avoiding model retraining. Several domain adaptation approaches are evaluated and compared. We simulated two possible online scenarios: i) block-wise adaptation and ii) sample-wise adaptation. In this study, we collect a dataset of 10 subjects performing a hand motor imagery task in 2 sessions. A publicly available dataset is also used.

RESULTS

For the first scenario, results indicate that classifier retraining can be avoided by means of our backward formulation yielding to equivalent classification performance as compared to retraining solutions. In the second scenario, classification performance rises up to 90.23\% overall accuracy when the label of the indicated mental task is used to learn the transport. Adaptive time is between 10 and 80 times faster than the other methods.

CONCLUSIONS

The proposed method is able to mitigate the cross-session variability in motor imagery BCIs.

SIGNIFICANCE

The backward formulation is an efficient retraining-free approach built to avoid lengthy calibration times. Thus, the BCI can be actively used after just a few minutes of setup. This is important for practical applications such as BCI-based motor rehabilitation.

Design of a variable stiffness index finger exoskeleton

This paper presents the design and experimentation of a variable stiffness index finger exoskeleton consisting of four-bar mechanisms actuated by a linear actuator. The lengths of the four-bar mechanism were optimized so that it can follow a recorded index fingertip trajectory. The mechanism has a fixed compliance at the coupler of the four-bar link and a variable compliance at the linear actuator that moves the four-bar. The skeletal shape of the coupler of the finger link has been optimized using FEM. The exoskeleton can apply a constant fingertip force irrespective of the position of the fingers.

Towards a mechanistic approach for the development of non-invasive brain-computer interfaces for motor rehabilitation

Brain-computer interfaces (BCIs) designed for motor rehabilitation use brain signals associated with motor-processing states to guide neuroplastic changes in a state-dependent manner. These technologies are uniquely positioned to induce targeted and functionally relevant plastic changes in the human motor nervous system. However, while several studies have shown that BCI-based neuromodulation interventions may improve motor function in patients with lesions in the central nervous system, the neurophysiological structures and processes targeted with the BCI interventions have not been identified. In this review, we first summarize current knowledge of the changes in the central nervous system associated with learning new motor skills. Then, we propose a classification of current BCI paradigms for plasticity induction and motor rehabilitation based on the expected neural plastic changes promoted. This classification proposes four paradigms based on two criteria: the plasticity induction methods and the brain states targeted. The existing evidence regarding the brain circuits and processes targeted with these different BCIs is discussed in detail. The proposed classification aims to serve as a starting point for future studies trying to elucidate the underlying plastic changes following BCI interventions.

A magnetoencephalography dataset for motor and cognitive imagery-based brain-computer interface

Recent advancements in magnetoencephalography (MEG)-based brain-computer interfaces (BCIs) have shown great potential. However, the performance of current MEG-BCI systems is still inadequate and one of the main reasons for this is the unavailability of open-source MEG-BCI datasets. MEG systems are expensive and hence MEG datasets are not readily available for researchers to develop effective and efficient BCI-related signal processing algorithms. In this work, we release a 306-channel MEG-BCI data recorded at 1KHz sampling frequency during four mental imagery tasks (i.e. hand imagery, feet imagery, subtraction imagery, and word generation imagery). The dataset contains two sessions of MEG recordings performed on separate days from 17 healthy participants using a typical BCI imagery paradigm. The current dataset will be the only publicly available MEG imagery BCI dataset as per our knowledge. The dataset can be used by the scientific community towards the development of novel pattern recognition machine learning methods to detect brain activities related to motor imagery and cognitive imagery tasks using MEG signals.

Optimization of Surface Electromyography-Based Neurofeedback Rehabilitation Intervention System

In this paper, we study the effects of the neurofeedback method of surface EMG on electrophysiology and evaluate its effects on postural control, balance, and motor function using relevant scales. We optimize the neurofeedback rehabilitation intervention system based on surface EMG, study the objective assessment of neurofeedback rehabilitation intervention of surface EMG, and initially try to apply mirror therapy to the treatment of surface EMG. According to the different treatment methods, they were divided into the drug-only group, drug combined with electroacupuncture group, drug combined with facial muscle function training group, and drug combined with electroacupuncture combined with facial muscle function training group. Starting from the 10th day of the disease course, a course of 15 days contains three courses of treatment with a 3-day break for each course. Patients were tested on day 10, day 25, and day 40 of the disease course and the results of each test were recorded and analyzed. The results of each test were recorded and analyzed. The efficacy of four different methods for simple neurofeedback rehabilitation was compared according to the mean ratio of the root mean square of the patient's affected and healthy sides. The close relationship between surface EMG neurofeedback rehabilitation intervention and rehabilitation efficacy was also investigated, and the effect of different feedback modes on neurofeedback rehabilitation intervention was explored for the neurofeedback protocol and whether the use of the optimized neurorehabilitation protocol could achieve improved efficacy and have a sustained effect. The study showed that neurofeedback training interventions based on optimized surface EMG can achieve good long-term results, as demonstrated by improved postural control, balance, and motor function of patients; optimized neurofeedback rehabilitation intervention systems; and guiding physicians or nurses to work more effective clinically.

Brain-computer interface robotics for hand rehabilitation after stroke: a systematic review

BACKGROUND

Hand rehabilitation is core to helping stroke survivors regain activities of daily living. Recent studies have suggested that the use of electroencephalography-based brain-computer interfaces (BCI) can promote this process. Here, we report the first systematic examination of the literature on the use of BCI-robot systems for the rehabilitation of fine motor skills associated with hand movement and profile these systems from a technical and clinical perspective.

METHODS

A search for January 2010-October 2019 articles using Ovid MEDLINE, Embase, PEDro, PsycINFO, IEEE Xplore and Cochrane Library databases was performed. The selection criteria included BCI-hand robotic systems for rehabilitation at different stages of development involving tests on healthy participants or people who have had a stroke. Data fields include those related to study design, participant characteristics, technical specifications of the system, and clinical outcome measures.

RESULTS

30 studies were identified as eligible for qualitative review and among these, 11 studies involved testing a BCI-hand robot on chronic and subacute stroke patients. Statistically significant improvements in motor assessment scores relative to controls were observed for three BCI-hand robot interventions. The degree of robot control for the majority of studies was limited to triggering the device to perform grasping or pinching movements using motor imagery. Most employed a combination of kinaesthetic and visual response via the robotic device and display screen, respectively, to match feedback to motor imagery.

CONCLUSION

19 out of 30 studies on BCI-robotic systems for hand rehabilitation report systems at prototype or pre-clinical stages of development. We identified large heterogeneity in reporting and emphasise the need to develop a standard protocol for assessing technical and clinical outcomes so that the necessary evidence base on efficiency and efficacy can be developed.

The Influence of Visual Attention on The Performance of A Novel Tactile P300 Brain-Computer Interface with Cheeks-Stim Paradigm

Tactile P300 brain-computer interface (BCI) generally has a worse accuracy and information transfer rate (ITR) than the visual-based BCI. It may be due to the fact that human beings have a relatively poor tactile perception. This study investigated the influence of visual attention on the performance of a tactile P300 BCI. We designed our paradigms based on a novel cheeks-stim paradigm which attached the stimulators on the subject's cheeks. Two paradigms were designed as follows: a paradigm with no visual attention and another paradigm with visual attention to the target position. Eleven subjects were invited to perform the two paradigms. We also recorded and analyzed the eyeball movement data during the paradigm with visual attention to explore whether the eyeball movement would have an effect on the BCI classification. The average online accuracy was 89.09% for the paradigm with visual attention, which was significantly higher than that of the paradigm with no visual attention (70.45%). Significant difference in ITR was also found between the two paradigms ([Formula: see text]). The results demonstrated that visual attention was an effective method to improve the performance of tactile P300 BCI. Our findings suggested that it may be feasible to complete an efficient tactile BCI system by adding visual attention.

Motor Imagery Hand Movement Direction Decoding Using Brain Computer Interface to Aid Stroke Recovery and Rehabilitation

Motor Imagery (MI)-based Brain Computer Interface (BCI) system is a potential technology for active neurorehabilitation of stroke patients by complementing the conventional passive rehabilitation methods. Research to date mainly focused on classifying left vs. right hand/foot MI of stroke patients. Though a very few studies have reported decoding imagined hand movement directions using electroencephalogram (EEG)-based BCI, the experiments were conducted on healthy subjects. Our work analyzes MI-based brain cortical activity from EEG signals and decodes the imagined hand movement directions in stroke patients. The decoded direction (left vs. right) of hand movement imagination is used to provide control commands to a motorized arm support on which patient's affected (paralyzed) arm is placed. This enables the patient to move his/her stroke-affected hand towards the intended (imagined) direction that aids neuroplasticity in the brain. The synchronization measure called Phase Locking Value (PLV), extracted from EEG, is the neuronal signature used to decode the directional movement of the MI task. Event-related desynchronization/synchronization (ERD/ERS) analysis on Mu and Beta frequency bands of EEG is done to select the time bin corresponding to the MI task. The dissimilarities between the two directions of MI tasks are identified by selecting the most significant channel pairs that provided maximum difference in PLV features. The training protocol has an initial calibration session followed by a feedback session with 50 trials of MI task in each session. The feedback session extracts PLV features corresponding to most significant channel pairs which are identified in the calibration session and is used to predict the direction of MI task in left/right direction. An average MI direction classification accuracy of 74.44% is obtained in performing the training protocol and 68.63% from the prediction protocol during feedback session on 16 stroke patients.

Neural activity modulations and motor recovery following brain-exoskeleton interface mediated stroke rehabilitation

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Motor intention based arm training targets activity-dependent neuroplasticity.

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80% of stroke participants recovered clinically relevant functional movements.

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Ipsi-lesional, delta-band EEG activity was highly correlated with motor recovery.

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Results suggest higher activation of ipsi-lesional hemisphere post-intervention.

Brain-machine interfaces (BMI) based on scalp EEG have the potential to promote cortical plasticity following stroke, which has been shown to improve motor recovery outcomes. However, the efficacy of BMI enabled robotic training for upper-limb recovery is seldom quantified using clinical, EEG-based, and kinematics-based metrics. Further, a movement related neural correlate that can predict the extent of motor recovery still remains elusive, which impedes the clinical translation of BMI-based stroke rehabilitation.

To address above knowledge gaps, 10 chronic stroke individuals with stable baseline clinical scores were recruited to participate in 12 therapy sessions involving a BMI enabled powered exoskeleton for elbow training. On average, 132 ± 22 repetitions were performed per participant, per session. BMI accuracy across all sessions and subjects was 79 ± 18% with a false positives rate of 23 ± 20%.

Post-training clinical assessments found that FMA for upper extremity and ARAT scores significantly improved over baseline by 3.92 ± 3.73 and 5.35 ± 4.62 points, respectively. Also, 80% participants (7 with moderate-mild impairment, 1 with severe impairment) achieved minimal clinically important difference (MCID: FMA-UE >5.2 or ARAT >5.7) during the course of the study. Kinematic measures indicate that, on average, participants’ movements became faster and smoother. Moreover, modulations in movement related cortical potentials, an EEG-based neural correlate measured contralateral to the impaired arm, were significantly correlated with ARAT scores (ρ = 0.72, p < 0.05) and marginally correlated with FMA-UE (ρ = 0.63, p = 0.051). This suggests higher activation of ipsi-lesional hemisphere post-intervention or inhibition of competing contra-lesional hemisphere, which may be evidence of neuroplasticity and cortical reorganization following BMI mediated rehabilitation therapy.

Assessing impact of channel selection on decoding of motor and cognitive imagery from MEG data

OBJECTIVE

Magnetoencephalography (MEG) based brain-computer interface (BCI) involves a large number of sensors allowing better spatiotemporal resolution for assessing brain activity patterns. There have been many efforts to develop BCI using MEG with high accuracy, though an increase in the number of channels (NoC) means an increase in computational complexity. However, not all sensors necessarily contribute significantly to an increase in classification accuracy (CA) and specifically in the case of MEG-based BCI no channel selection methodology has been performed. Therefore, this study investigates the effect of channel selection on the performance of MEG-based BCI.

APPROACH

MEG data were recorded for two sessions from 15 healthy participants performing motor imagery, cognitive imagery and a mixed imagery task pair using a unique paradigm. Performance of four state-of-the-art channel selection methods (i.e. Class-Correlation, ReliefF, Random Forest, and Infinite Latent Feature Selection were applied across six binary tasks in three different frequency bands) were evaluated in this study on two state-of-the-art features, i.e. bandpower and common spatial pattern (CSP).

MAIN RESULTS

All four methods provided a statistically significant increase in CA compared to a baseline method using all gradiometer sensors, i.e. 204 channels with band-power features from alpha (8-12 Hz), beta (13-30 Hz), or broadband (α + β) (8-30 Hz). It is also observed that the alpha frequency band performed better than the beta and broadband frequency bands. The performance of the beta band gave the lowest CA compared with the other two bands. Channel selection improved accuracy irrespective of feature types. Moreover, all the methods reduced the NoC significantly, from 204 to a range of 1-25, using bandpower as a feature and from 15 to 105 for CSP. The optimal channel number also varied not only in each session but also for each participant. Reducing the NoC will help to decrease the computational cost and maintain numerical stability in cases of low trial numbers.

SIGNIFICANCE

The study showed significant improvement in performance of MEG-BCI with channel selection irrespective of feature type and hence can be successfully applied for BCI applications.

Action observation training and brain-computer interface controlled functional electrical stimulation enhance upper extremity performance and cortical activation in patients with stroke: a randomized controlled trial

PURPOSE

Brain-computer interface (BCI)-functional electronic stimulation (FES) systems are increasingly being explored as potential neuro-rehabilitation tools. Here, we investigate the effect of action observation training (AOT) plus electroencephalogram (EEG)-based BCI-controlled FES system on motor recovery of upper extremity and cortical activation in patients with stroke.

METHOD

There were a total of 26 patients: an AOT plus BCI-FES group (n = 13) and a control group (n = 13). The control group performed FES treatment and the conventional physical therapy, while the AOT plus BCI-FES group performed AOT plus BCI-FES and the conventional physical therapy. Upper extremity performance was measured using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL) and Modified Barthel Index (MBI). Cortical activation was measured using electro-encephalographic recordings from alpha and beta power, concentration, and activation.

RESULTS

After intervention, there were significant differences between two groups in FMA-UE, WMFT, MAL and MBI and the results of EEG including alpha power, beta power, concentration and activation.

CONCLUSIONS

This study demonstrated that AOT plus BCI-FES can enhance motor function of upper extremity and cortical activation in patients with stroke. This training method may be feasible and suitable for individuals with stroke.

Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis

BACKGROUND

A substantial number of clinical studies have demonstrated the functional recovery induced by the use of brain-computer interface (BCI) technology in patients after stroke. The objective of this review is to evaluate the effect sizes of clinical studies investigating the use of BCIs in restoring upper extremity function after stroke and the potentiating effect of transcranial direct current stimulation (tDCS) on BCI training for motor recovery.

METHODS

The databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and PEDro) were systematically searched for eligible single-group or clinical controlled studies regarding the effects of BCIs in hemiparetic upper extremity recovery after stroke. Single-group studies were qualitatively described, but only controlled-trial studies were included in the meta-analysis. The PEDro scale was used to assess the methodological quality of the controlled studies. A meta-analysis of upper extremity function was performed by pooling the standardized mean difference (SMD). Subgroup meta-analyses regarding the use of external devices in combination with the application of BCIs were also carried out. We summarized the neural mechanism of the use of BCIs on stroke.

RESULTS

A total of 1015 records were screened. Eighteen single-group studies and 15 controlled studies were included. The studies showed that BCIs seem to be safe for patients with stroke. The single-group studies consistently showed a trend that suggested BCIs were effective in improving upper extremity function. The meta-analysis (of 12 studies) showed a medium effect size favoring BCIs for improving upper extremity function after intervention (SMD = 0.42; 95% CI = 0.18-0.66; I² = 48%; P < 0.001; fixed-effects model), while the long-term effect (five studies) was not significant (SMD = 0.12; 95% CI = - 0.28 - 0.52; I² = 0%; P = 0.540; fixed-effects model). A subgroup meta-analysis indicated that using functional electrical stimulation as the external device in BCI training was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor imagery (P = 0.070). The use of tDCS (two studies) could not further facilitate the effects of BCI training to restore upper extremity motor function (SMD = - 0.30; 95% CI = - 0.96 - 0.36; I² = 0%; P = 0.370; fixed-effects model).

CONCLUSION

The use of BCIs has significant immediate effects on the improvement of hemiparetic upper extremity function in patients after stroke, but the limited number of studies does not support its long-term effects. BCIs combined with functional electrical stimulation may be a better combination for functional recovery than other kinds of neural feedback. The mechanism for functional recovery may be attributed to the activation of the ipsilesional premotor and sensorimotor cortical network.