Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic
paresis after stroke
Sammanfattning
OBJECTIVE: Brain computer interface technology is of great interest to researchers as a
potential therapeutic measure for people with severe neurological disorders. The aim of this study
was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular
electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using
an A-B-A-B withdrawal single-subject design.
METHODS: A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated
in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers
during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity.
In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related
cortical potential was observed in the electroencephalogram.
RESULTS: The subject initially showed diffuse functional magnetic resonance imaging activation and
small electro-encephalogram responses while attempting finger movement. Epoch A was associated
with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was
associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level
dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG
coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone
was observed.
CONCLUSION: These results indicate that self-directed training with a brain computer interface may
induce activity-
dependent cortical plasticity and promote functional recovery.
This preliminary clinical investigation encourages further research using a controlled design.