Combination of Brain-Computer Interface Training and Goal-Directed Physical Therapy in Chronic Stroke: A Case Report

Author:

Broetz Doris1,Braun Christoph2,Weber Cornelia3,Soekadar Surjo R.4,Caria Andrea4,Birbaumer Niels5

Affiliation:

1. Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tübingen, Germany,

2. Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tübingen, Germany, CIMeC Center for Mind/Brain Sciences, University of Trento, Italy

3. Fondazione Santa Lucia, Laboratorio di Neuropsicologia, Roma, Italy

4. Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tübingen, Germany

5. Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tübingen, Germany, Ospedale San Camillo, Istituto di Ricovero e Curattere Scientifico, IRCCS, Venezia, Italy

Abstract

Background. There is no accepted and efficient rehabilitation strategy to reduce focal impairments for patients with chronic stroke who lack residual movements. Methods . A 67-year-old hemiplegic patient with no active finger extension was trained with a brain—computer interface (BCI) combined with a specific daily life—oriented physiotherapy. The BCI used electrical brain activity (EEG) and magnetic brain activity (MEG) to drive an orthosis and a robot affixed to the patient’s affected upper extremity, which enabled him to move the paralyzed arm and hand driven by voluntary modulation of μ-rhythm activity. In addition, the patient practiced goal-directed physiotherapy training. Over 1 year, he completed 3 training blocks. Arm motor function, gait capacities (using Fugl-Meyer Assessment, Wolf Motor Function Test, Modified Ashworth Scale, 10-m walk speed, and goal attainment score), and brain reorganization (functional MRI, MEG) were repeatedly assessed. Results. The ability of hand and arm movements as well as speed and safety of gait improved significantly (mean 46.6%). Improvement of motor function was associated with increased μ-oscillations in the ipsilesional motor cortex. Conclusion. This proof-of-principle study suggests that the combination of BCI training with goal-directed, active physical therapy may improve the motor abilities of chronic stroke patients despite apparent initial paralysis.

Publisher

SAGE Publications

Subject

General Medicine

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