Abstract
Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.
Highlights
Stroke is a leading cause for long-term disability and often results in poor quality of life [1]
While there is a good chance for full recovery from mild paresis, this is less likely for severe upper limb paresis [7]
Considering the reduced effort needed in comparison to robotic-guided therapy, the applicability in chronic patients and the practicability in bimanual tasks, brain-machine interfaces (BMIs) hand exoskeleton training is well suited for outpatient occupational therapy (Phase E)
Summary
Stroke is a leading cause for long-term disability and often results in poor quality of life [1]. With a growing number of stroke survivors, the number of patients facing post-stroke impairments is increasing. Speech, mood regulation or sexual function, loss of motor function, especially in the upper extremity, is a severe burden after stroke. Upper limb impairment occurs in approximately 80% of stroke survivors [5]. In 30–50% of all stroke survivors, the affected arm is still severely impaired 6 months after stroke [8, 9]. This group face immense difficulties in performing activities of daily living (ADLs) and must often rely on family support or caregivers [10]. Given the rising burden of stroke, there is a pressing need for innovative tools that foster successful restoration of motor function
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