Brain–Computer Interfaces in Poststroke Rehabilitation: a Clinical Neuropsychological Study

Abstract

Objectives. To assess the efficacy of using a brain–computer interface with a hand exoskeleton (BCI–exoskeleton) in the complex rehabilitation of patients with the sequelae of cerebrovascular accidents and to determine the minimally adequate reserves of cognitive functions required for the patient to carry out effective mental training using the movement imagination paradigm. Materials and methods. The study included 55 patients (median age 54.0 [44.0; 61.0] years, median time since stroke 6.0 [3.0; 13.0] months) in study and control (simulation of BCI) groups. The severity of paresis was evaluated on the Fugl–Meyer Assessment of Motor Recovery after Stroke (FMA) scale and the Action Research Arm Test (ARAT). Neuropsychological investigations to identify predictors for learning by movement imagination were carried out in 12 patients of the study group before training started. After investigations, patients received courses of movement imagination (hand extension) training using a BCI to control a hand exoskeleton. On average, patients received 10 30-min training sessions. After training, repeat assessments of parameters on motor scales were run, along with analysis of electroencephalography data obtained during training sessions; these results were compared with neuropsychological investigation data. Results and conclusions. Both groups showed improvements in upper limb motor function on the ARAT and Fugl–Meyer (sections A–D, H, I) scales. Only the BCI-exoskeleton group showed improvements in the ball grasp (p = 0.012), finger pinch grip (p = 0.012), and gross arm movements (p = 0.002) scores on the ARAT scale. A significant correlation was found between BCI movement quality indicators with various neuropsychological test results: Taylor figures, Head test, reaction choice test. Thus, inclusion of the BCI-exoskeleton system into the complex rehabilitation of patients with poststroke upper limb paresis significantly improves a number of measures of grasping and movement functions in the proximal segments of the upper limb. Use of neuropsychological tests as screening to select patients may help with the personalized application of rehabilitation technologies.