Abstract
Brain stroke affects millions of people in the world every year, with 50 to 60 percent of stroke survivors suffering from functional disabilities, for which early and sustained post-stroke rehabilitation is highly recommended. However, approximately one third of stroke patients do not receive early in hospital rehabilitation programs due to insufficient medical facilities or lack of motivation. Gait triggered mixed reality (GTMR) is a cognitive-motor dual task with multisensory feedback tailored for lower-limb post-stroke rehabilitation, which we propose as a potential method for addressing these rehabilitation challenges. Simultaneous gait and EEG data from nine stroke patients was recorded and analyzed to assess the applicability of GTMR to different stroke patients, determine any impacts of GTMR on patients, and better understand brain dynamics as stroke patients perform different rehabilitation tasks. Walking cadence improved significantly for stroke patients and lower-limb movement induced alpha band power suppression during GTMR tasks. The brain dynamics and gait performance across different severities of stroke motor deficits was also assessed; the intensity of walking induced event related desynchronization (ERD) was found to be related to motor deficits, as classified by Brunnstrom stage. In particular, stronger lower-limb movement induced ERD during GTMR rehabilitation tasks was found for patients with moderate motor deficits (Brunnstrom stage IV). This investigation demonstrates the efficacy of the GTMR paradigm for enhancing lower-limb rehabilitation, explores the neural activities of cognitive-motor tasks in different stages of stroke, and highlights the potential for joining enhanced rehabilitation and real-time neural monitoring for superior stroke rehabilitation.
Highlights
P OST-STROKE rehabilitation is a long term battle, which includes many different stages and approaches throughout the course of a patient’s recovery
Significant improvement occurred in the stage IV patients, which increased from a group average of 76.1 steps/min to 89.5 steps/min, near the target cadence of 90 steps/min, though notably this is driven by large increases by subjects C and E
The Stage III subjects did not show improvements, and displayed nominally decreased active range of motion (AROM) angles for both legs in the Gait triggered mixed reality (GTMR) task. This discrepancy is suspected to be an influence of cognitive motor interference, which is common for dual task rehabilitation, with the fact that it is exhibited in both legs
Summary
P OST-STROKE rehabilitation is a long term battle, which includes many different stages and approaches throughout the course of a patient’s recovery. Creative assist approaches have utilized novel technologies to transform traditional rehabilitation processes into efficient, intriguing experiences in order to raise motivation and accelerate different stages of the rehabilitation progress, such as robotic assisted systems [1]–[4], virtual reality (VR) [5]–[9], and brain-computer interfaces [4], [8]–[11]. As non-invasive brain imaging techniques, such as electroencephalography (EEG), have emerged and become more widely used, there has been an increase of attention to the importance of CNS condition and neural activity during stroke rehabilitation
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