Category: Stroke; Technology (e.g. robotics, assistive technology, mHealth); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To investigate the efficacy of a brain computer interface (BCI) system (Neurolutions IpsiHand) as a method to restore function and enhance neuroplasticity in motor impaired patients after stroke.
Design : Ten chronic hemiparetic stroke survivors with moderate-to-severe upper-limb motor impairment (mean Action Research Arm Test=13.4) used a powered exoskeleton that opened and closed the affected hand using electroencephalographic (EEG) signals from the unaffected hemisphere associated with imagined hand movements of the paretic limb. The study was a self-controlled study comparing motor function before and after the intervention to establish the feasibility of the BCI-driven therapy.
Setting : Patients used the system at home for 12 weeks.
Participants (or Animals, Specimens, Cadavers) : Ten chronic hemiparetic stroke survivors with moderate-to-severe upper-limb hemiparesis, enrolled at least 6 months after first-time hemispheric stroke, completed the study.
Interventions : BCI (Brain Computer Interface) driven powered exoskeleton for hand and arm rehab after stroke.
Main Outcome Measure(s) : The primary outcome measure was the Action Research Arm Test (ARAT). Secondary outcome measures included: (1) the Canadian Occupational Performance Measure, (2) the Motricity Index, (3) the modified Ashworth Scale at the elbow joint, (4) grip strength, (5) pinch strength, and (6) the active range of motion (AROM) at the metacarpophalangeal joint of digits 2 to 5.
Results : Patients had a statistically significant mean ARAT increase of 6.2 points. Importantly, 5.7 points has been estimated to represent the minimal clinically important difference in chronic stroke survivors. Specifically, 6 of the 10 patients had ARAT improvements above this level. Grasp strength, Motricity Index, the grip and grasp ARAT subscores, and Canadian Occupational Performance Measure performance and satisfaction ratings were also significantly increased after therapy.
Conclusions : This feasibility study shows a statistically significant and clinically meaningful improvement in the motor function of chronic stroke survivors after using a home-based BCI-controlled exoskeleton. The use of control features in the contralesional hemisphere shows evidence of the potential relevance of the unaffected hemisphere for functional rehabilitation. Although this study represents an important step toward developing and translating BCI-driven rehabilitation protocols for chronic stroke survivors, the effectiveness of BCI-driven therapies must be proven in large randomized controlled trials before full acceptance.