Brain-Computer Interface Training With Functional Electrical Stimulation: Facilitating Changes in Interhemispheric Functional Connectivity and Motor Outcomes Post-stroke.

Anita M Sinha,Vivek Prabhakaran,Veena A Nair

doi:10.3389/fnins.2021.670953

Anita M Sinha, Vivek Prabhakaran + Show 1 more

Open Access

https://doi.org/10.3389/fnins.2021.670953

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Journal: Frontiers in neuroscience	Publication Date: Sep 27, 2021
Citations: 12	License type: CC BY 4.0

Affiliation: University of Wisconsin–Madison

Abstract

While most survivors of stroke experience some spontaneous recovery and receive treatment in the subacute setting, they are often left with persistent impairments in upper limb sensorimotor function which impact autonomy in daily life. Brain-Computer Interface (BCI) technology has shown promise as a form of rehabilitation that can facilitate motor recovery after stroke, however, we have a limited understanding of the changes in functional connectivity and behavioral outcomes associated with its use. Here, we investigate the effects of EEG-based BCI intervention with functional electrical stimulation (FES) on resting-state functional connectivity (rsFC) and motor outcomes in stroke recovery. 23 patients post-stroke with upper limb motor impairment completed BCI intervention with FES. Resting-state functional magnetic resonance imaging (rs-fMRI) scans and behavioral data were collected prior to intervention, post- and 1-month post-intervention. Changes in rsFC within the motor network and behavioral measures were investigated to identify brain-behavior correlations. At the group-level, there were significant increases in interhemispheric and network rsFC in the motor network after BCI intervention, and patients significantly improved on the Action Research Arm Test (ARAT) and SIS domains. Notably, changes in interhemispheric rsFC from pre- to both post- and 1 month post-intervention correlated with behavioral improvements across several motor-related domains. These findings suggest that BCI intervention with FES can facilitate interhemispheric connectivity changes and upper limb motor recovery in patients after stroke.

Highlights

800,000 people experience a new or recurrent stroke in the United States each year (Benjamin et al, 2017)
With the aim to investigate the effects of Brain-Computer Interface (BCI) intervention on motor network functional connectivity at the group-level, we combined NetworkBased Statistic (NBS) with generalized estimating equations (GEE) (Hanley et al, 2003) to identify statistically significant connections at each time point and assess how they changed over time
The current study provides new evidence that suggest that noninvasive EEG-based BCI with functional electrical stimulation (FES) intervention can facilitate changes in interhemispheric interactions and improve behavioral outcomes for patients of stroke with upper extremity impairment

Summary

Introduction

800,000 people experience a new or recurrent stroke in the United States each year (Benjamin et al, 2017). During the recovery phase of stroke, the primary standards of care include physiotherapy and/or occupational therapy. These treatments only provide patients with partial recovery of motor function, resulting in learned non-use of the affected limb and eventual further loss of motor function (Ballester et al, 2016). To address and solve this unmet need for more effective therapies, there is a concerted effort to develop alternative approaches to restore upper limb motor function post-stroke. It is crucial that we further investigate the efficacy of these and other methods to determine which rehabilitation approaches can offer maximal benefit for individuals recovering from stroke

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