Abstract
This study aims to examine the changes in task-related brain activity induced by rehabilitative therapy using brain-computer interface (BCI) technologies and whether these changes are relevant to functional gains achieved through the use of these therapies. Stroke patients with persistent upper-extremity motor deficits received interventional rehabilitation therapy using a closed-loop neurofeedback BCI device (n = 8) or no therapy (n = 6). Behavioral assessments using the Stroke Impact Scale, the Action Research Arm Test (ARAT), and the Nine-Hole Peg Test (9-HPT) as well as task-based fMRI scans were conducted before, during, after, and 1 month after therapy administration or at analogous intervals in the absence of therapy. Laterality Index (LI) values during finger tapping of each hand were calculated for each time point and assessed for correlation with behavioral outcomes. Brain activity during finger tapping of each hand shifted over the course of BCI therapy, but not in the absence of therapy, to greater involvement of the non-lesioned hemisphere (and lesser involvement of the stroke-lesioned hemisphere) as measured by LI. Moreover, changes from baseline LI values during finger tapping of the impaired hand were correlated with gains in both objective and subjective behavioral measures. These findings suggest that the administration of interventional BCI therapy can induce differential changes in brain activity patterns between the lesioned and non-lesioned hemispheres and that these brain changes are associated with changes in specific motor functions.
Highlights
Stroke remains a growing source of disability, with nearly 800,000 individuals in the United States alone experiencing a stroke each year and a projected increase of 22% in stroke prevalence by 2030 (Go et al, 2013)
With an association between decreases in Laterality Index (LI) and gains in behavioral measures. This consistency was not noted in correlation analyses examining potential relationships between changes in LI values and changes in functional measures assessed during the control phase of the experiment. The findings in this preliminary report on the neuroplastic effects of brain-computer interface (BCI) therapy when applied to stroke rehabilitation show changes in task-related brain activation induced by interventional rehabilitative therapy using a closed-loop neurofeedback BCI device
These patterns of change noted in our activation maps were further quantified using LI analyses, which demonstrated shifts in activity with BCI therapy from the ipsilesional hemisphere to greater involvement of the contralesional hemisphere during tapping of the impaired hand and increased lateralization of activity to the hemisphere contralateral to the unaffected hand during tapping of the unimpaired hand
Summary
Stroke remains a growing source of disability, with nearly 800,000 individuals in the United States alone experiencing a stroke each year and a projected increase of 22% in stroke prevalence by 2030 (Go et al, 2013). Despite increases in stroke incidence, stroke deaths have declined in recent years (Go et al, 2013), such that the majority of stroke patients survive their initial stroke event. Individuals in this growing population of stroke survivors are often left with persistent functional deficits. Current guidelines note that there exists a lack of evidence to guide the optimal selection of a particular type, intensity, and amount of rehabilitative motor therapy for stroke survivors (Miller et al, 2010), and many stroke patients reach a functional plateau before complete recovery is achieved despite the use of currently available standard rehabilitative therapies. Studies have suggested that clinically relevant plasticity and recovery potential still persist even after this plateau has been reached and that it may be possible to harness this reserve of recovery potential through the use of alternative, non-traditional therapies (Cramer, 2010) that incorporate components such as virtual reality (Orihuela-Espina et al, 2013), robot-assisted movement therapy (Lo et al, 2010; Pinter et al, 2013), and constraint-induced
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