OBJECTIVE:Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study. METHODS:Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention. RESULTS: A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. INTERPRETATION: The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation.
RCT Entities:
OBJECTIVE:Chronic strokepatients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study. METHODS: Thirty-two chronic strokepatients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention. RESULTS: A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. INTERPRETATION: The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic strokepatients without residual finger movements and may open a new door in stroke neurorehabilitation.
Authors: Natalie Mrachacz-Kersting; Ning Jiang; Andrew James Thomas Stevenson; Imran Khan Niazi; Vladimir Kostic; Aleksandra Pavlovic; Sasa Radovanovic; Milica Djuric-Jovicic; Federica Agosta; Kim Dremstrup; Dario Farina Journal: J Neurophysiol Date: 2015-12-30 Impact factor: 2.714
Authors: Ranganatha Sitaram; Tomas Ros; Luke Stoeckel; Sven Haller; Frank Scharnowski; Jarrod Lewis-Peacock; Nikolaus Weiskopf; Maria Laura Blefari; Mohit Rana; Ethan Oblak; Niels Birbaumer; James Sulzer Journal: Nat Rev Neurosci Date: 2016-12-22 Impact factor: 34.870
Authors: S L Norman; D J McFarland; A Miner; S C Cramer; E T Wolbrecht; J R Wolpaw; D J Reinkensmeyer Journal: J Neural Eng Date: 2018-07-31 Impact factor: 5.379
Authors: Jane E Huggins; Christoph Guger; Brendan Allison; Charles W Anderson; Aaron Batista; Anne-Marie A-M Brouwer; Clemens Brunner; Ricardo Chavarriaga; Melanie Fried-Oken; Aysegul Gunduz; Disha Gupta; Andrea Kübler; Robert Leeb; Fabien Lotte; Lee E Miller; Gernot Müller-Putz; Tomasz Rutkowski; Michael Tangermann; David Edward Thompson Journal: Brain Comput Interfaces (Abingdon) Date: 2014-01