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Brain-machine interface in chronic stroke rehabilitation: a controlled study.

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Ramos-Murguialday, Ander [University of Tuebingen] Brötz, Doris [University of Tuebingen] Rea, Massimiliano [University of Tuebingen] Leaer [University of Tuebingen] Yilmaz, Ozge [University of Tuebingen] Liberati, Giulia [UCL] Birbaumer, Niels

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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès interdit
Publication date 2013
Language Anglais
Journal information "Annals of Neurology" - Vol. 74, no. 1, p. 100-108 (2013)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) Hoboken)
issn 0364-5134
e-issn 1531-8249
Publication status Publié
Affiliation UCL - SSS/IONS - Institute of NeuroScience
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Bibliographic reference Ramos-Murguialday, Ander ; Brötz, Doris ; Rea, Massimiliano ; Leaer ; Yilmaz, Ozge ; et. al. Brain-machine interface in chronic stroke rehabilitation: a controlled study.. In: Annals of Neurology, Vol. 74, no. 1, p. 100-108 (2013)
Permanent URL http://hdl.handle.net/2078.1/154991