Abstract
Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately after, and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26] = 6.367, p = 0.006) and ARAT (F[2,26] = 7.230, p = 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training.Clinical Trial Registration: This study has been registered at ClinicalTrials.gov with clinical trial registration number NCT02323061.
Highlights
Stroke survivors require high demand in rehabilitation and longterm care services, especially for upper extremity motor function (Norouzi-Gheidari et al, 2012)
The inclusion criteria were (1) first-ever stroke, (2) onset of stroke diagnose more than 6 months, (3) a single unilateral brain lesion, (4) sufficient cognition and comprehensive ability to understand and perform corresponding tasks assessed by Montreal Cognitive Assessment (MoCA) with a score of >21, (5) moderate to severe motor dysfunctions for the paretic upper extremity (Fugl-Meyer Assessment for upper-extremity score < 47) (Woodbury et al, 2013) and (6) no additional rehabilitation therapies applied to the subject during the intervention
The result indicated that the Brain-computer interface (BCI) robot hand training was able to promote motor recovery with a long-term effect
Summary
Stroke survivors require high demand in rehabilitation and longterm care services, especially for upper extremity motor function (Norouzi-Gheidari et al, 2012). Brain-computer interface (BCI)-guided training therapy has been promoted as a post-stroke motor rehabilitation training tool. Combining the BCI system with a unilateral robotic hand technology makes it possible for stroke subjects to control the robotic hand with his/her brain signals, in order to restore the paretic hand function by promoting neuroplasticity and facilitating motor relearning (Frolov et al, 2017; Carino-Escobar et al, 2019). Clinical evidence showed that BCI-guided training elicits clinically significant and long-lasting motor recovery in chronic stroke survivors (Biasiucci et al, 2018; Ramos-Murguialday et al, 2019). A meta-analysis suggested that BCI technology could be a more effective intervention for post-stroke upper-limb rehabilitation than other conventional therapies (Cervera et al, 2018). Studies comparing distal and proximal robot-assisted training therapies showed that distal training exhibited better performance than proximal training in the whole upper-limb (Hsieh et al, 2018; Qian et al, 2019)
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