Abstract 6: Resting-state Functional Connectivity Changes After Stroke Rehabilitation Using Closed Loop Neurofeedback

Abstract

Introduction: Brain-computer interface (BCI)-EEG is a promising intervention for improving motor function after stroke. However, brain changes following intervention on a BCI-EEG system are not yet fully understood. We examined changes in resting state functional connectivity (RSFC) MRI in the motor network defined by 6 key regions in the left and right primary motor cortex (M1), left and right supplementary motor area (SMA), and left and right premotor cortex (PMC). Additionally, we investigated brain-behavior correlation between rsFC and a battery of outcome measures including the Barthel Index (BI), the Stroke Impact Scale(SIS), and the Action Research Arm Test (ARAT). Methods: Fifteen stroke patients with persistent mild to severe upper extremity impairment following ischemic stroke received intervention using BCI-EEG and were tested before (T1) and at 2-3 weeks (T2) mid intervention. 11 of these patients were also tested a third time at 4-6 weeks at the end of intervention (T3). Eyes closed, 10 minute resting fMRI and anatomical scans were acquired on a GE 3T MRI scanner. Right hemisphere stroke patients’ scans were flipped so that as a group the lesion was in the left (L) hemisphere and the impaired limb right (R). Seed region based connectivity analyses were performed to examine changes in RSFC over time and in inter-hemispheric and intra-hemispheric connectivity, and correlations between brain changes and behavioral changes were investigated. Results: BCI-EEG intervention led to significant increase in intra-hemispheric connectivity (p = .03) from T1 to T3. Inter-hemispheric connectivity increased from T1 to T3, trending towards significance (p = .06). Significant positive correlations were observed between changes in RSFC (L.M1 and L.PMC, L.M1 and R.PMC, L.SMA and R.PMC, and R.PMC and R.SMA) and change in upper extremity BI score (p ranging from .01 to .001); changes in RSFC between L.PMC and R.PMC correlated with hand strength on the SIS (p = .03). A trend was observed between increase in RSFC (L.M1 and R.PMC) and increase in total ARAT score but this was not significant. Conclusions: Results suggest that BCI-EEG intervention facilitate changes in RSFC in the motor network in stroke patients and these changes are associated with improved outcomes.