The purpose of this study is to provide an important reference for the standard clinical operation of motor imagery brain-computer interface (MI-BCI) for upper limb motor dysfunction after stroke.
The rehabilitation effect of patients with moderate or severe upper limb motor dysfunction after stroke is poor, which has been the focus of research owing to the difficulties encountered. Brain-computer interface (BCI) represents a hot frontier technology in brain neuroscience research. It refers to the direct conversion of the sensory perception, imagery, cognition, and thinking of users or subjects into actions, without reliance on peripheral nerves or muscles, to establish direct communication and control channels between the brain and external devices. Motor imagery brain-computer interface (MI-BCI) is the most common clinical application of rehabilitation as a non-invasive means of rehabilitation. Previous clinical studies have confirmed that MI-BCI positively improves motor dysfunction in patients after stroke. However, there is a lack of clinical operation demonstration. To that end, this study describes in detail the treatment of MI-BCI for patients with moderate and severe upper limb dysfunction after stroke and shows the intervention effect of MI-BCI through clinical function evaluation and brain function evaluation results, thereby providing ideas and references for clinical rehabilitation application and mechanism research.
Nearly 85% of stroke patients have motor dysfunction1, especially due to the limited rehabilitation effect of patients with moderate and severe upper limb motor dysfunction, which seriously affects patients’ ability to live independent daily lives and has been the focus and difficulty of research. Non-invasive brain-computer interface (BCI) is known as an emerging treatment for rehabilitation of motor dysfunction after stroke2. BCI is the direct conversion of the sensory perception, imagery, cognition, and thinking of users or subjects into actions, without reliance on peripheral nerves or muscles, to establish direct communication and control channels between the brain and external devices3. At present, the paradigms of BCI for clinical rehabilitation include motor imagery (MI), steady-state visual evoked potentials (SSVEP), and auditory evoked potentials (AEP) P3004, of which the most commonly used and convenient is motor imagery brain-computer interface (MI-BCI). MI is an intervention that uses visual/kinesthetic motor imagery to visualize the execution of motor tasks (such as hand, arm, or foot movements). On the one hand, previous studies have demonstrated that activation of the associated motor cortex during MI is similar to actual motor execution5. On the other hand, unlike other paradigms, MI can activate a specific area of activity through motor memory without any external stimulus to improve motor function; this is conducive to implementation in stroke patients, especially when combined with hearing dysfunction6.
Moreover, MI-BCI has been shown to have a positive effect on improving motor dysfunction in stroke patients. Cheng et al. reported that compared with simple soft robotic glove intervention, the soft robotic glove based on MI-BCI combined with tasks oriented to daily life activities showed more obvious functional improvement and more lasting kinesthetic experience in chronic stroke patients after 6 weeks of intervention. Furthermore, it was also able to elicit the perception of motor movements7. Additionally, Ang et al. included 21 chronic stroke patients with moderate to severe upper limb dysfunction for randomized intervention. The clinical function was evaluated before and after intervention by the Fugl-Meyer assessment of upper extremity (FMA-UE). The results showed that, compared with simple haptic knob (HK) robot intervention (HK group) and standard arm therapy intervention (SAT group), the motion gain effect of HK based on MI-BCI intervention (BCI-HK group) was significantly better than that of the other two groups8. However, the specific operation of MI-BCI still requires normative standards, and the mechanism of neural remodeling must be fully understood, which limits the clinical application and promotion of MI-BCI. Therefore, by showing the intervention process of MI-BCI in a 36-year-old male stroke patient with upper limb motor dysfunction, this study will summarize the functional outcome changes and brain function remodeling before and after the intervention to demonstrate the complete operation process of MI-BCI and provide ideas and references for clinical rehabilitation application and mechanism research.
The rehabilitation period for moderate and severe upper limb motor dysfunction after stroke is long and the recovery is difficult, which has always been the focus of clinical rehabilitation research18. Traditional upper limb rehabilitation training is mostly simple peripheral intervention or central intervention19. Meanwhile, due to the lack of active participation of patients with moderate and severe limb dysfunction, passive treatment is mainly used, with poor rehabilitat…
The authors have nothing to disclose.
This study was supported by the National Science Foundation of Guangdong Province (No.2023A1515010586), Guangzhou clinical characteristic technology construction project (2023C-TS19), Education Science Planning Project of Guangdong Province (No.2022GXJK299), the General Guidance Program of Guangzhou Municipal Health and Family Planning (20221A011109, 20231A011111), 2022 Guangzhou Higher Education Teaching Quality and Teaching Reform Project of Higher Education Teaching reform General project (No.2022JXGG088/02-408-2306040XM), 2022 Guangzhou Medical University Student Innovation Ability Improvement Plan project (No.PX-66221494/02-408-2304-19062XM), 2021 school-level education science planning project (2021: NO.45), 2023 First-class Undergraduate Major Construction Fund of high-level University (2022JXA009, 2022JXD001, 2022JXD003)/(02-408-2304-06XM), Guangzhou Education Bureau university research project (No. 202235384), 2022 Undergraduate Teaching Quality and Teaching Reform Project of Guangzhou Medical University (2022 NO. 33), National Science Foundation of Guangdong Province (No. 2021A1515012197), and Guangzhou and University Foundation (No. 202102010100).
MI-BCI | Rui Han, China | RuiHan Bangde | NA |
E-Prime | version 3.0 | behavioral research software. | |
fNIRS | Hui Chuang, China | NirSmart-500 | NA |
NirSpark | preprocess near-infrared data |