Proof of Principle of a Brain-Computer Interface Approach to Support Poststroke Arm Rehabilitation in Hospitalized Patients: Design, Acceptability, and Usability

Abstract

ObjectiveTo evaluate the feasibility of brain-computer interface (BCI)-assisted motor imagery training to support hand/arm motor rehabilitation after stroke during hospitalization. DesignProof-of-principle study. SettingNeurorehabilitation hospital. ParticipantsConvenience sample of patients (N=8) with new-onset arm plegia or paresis caused by unilateral stroke. InterventionsThe BCI-based intervention was administered as an “add-on” to usual care and lasted 4 weeks. Under the supervision of a therapist, patients were asked to practice motor imagery of their affected hand and received as a discrete feedback the movements of a “virtual” hand superimposed on their own. Such a BCI-based device was installed in a rehabilitation hospital ward. Main Outcome MeasuresFollowing a user-centered design, we assessed system usability in terms of motivation, satisfaction (by means of visual analog scales), and workload (National Aeronautics and Space Administration–Task Load Index). The usability of the BCI-based system was also evaluated by 15 therapists who participated in a focus group. ResultsAll patients successfully accomplished the BCI training. Significant positive correlations were found between satisfaction and motivation (P=.001, r=.393). BCI performance correlated with interest (P=.027, r=.257) and motivation (P=.012, r=.289). During the focus group, professionals positively acknowledged the opportunity offered by BCI-assisted training to measure patients' adherence to rehabilitation. ConclusionsAn ecological BCI-based device to assist motor imagery practice was found to be feasible as an add-on intervention and tolerable by patients who were exposed to the system in the rehabilitation environment.