Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany; Health Technologies Department, Tecnalia, San Sebastian, Spain.
Ann Neurol. 2013 Jul;74(1):100-8. doi: 10.1002/ana.23879. Epub 2013 Aug 7.
Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study.
Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention.
A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups.
The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation.
严重手部无力的慢性中风患者对康复治疗反应不佳。在这里，我们评估了每日脑机接口 (BMI) 训练的疗效，以增加假设的单独物理治疗对严重弛缓患者的有益影响，这是一项双盲假对照设计的概念验证研究。
32 名严重手部无力的慢性中风患者被随机分配到 2 个匹配组，并参加了 17.8 ± 1.4 天的训练，奖励同侧振荡感觉运动节律的去同步化，与手部和手臂矫形器的在线运动一致（实验组，n = 16）。在对照组（假手术组，n = 16）中，矫形器的运动是随机发生的。两组在 BMI 训练或对照干预后立即接受相同的行为物理治疗。在干预前后评估上肢运动功能评分、手臂和手部肌肉的肌电图、安慰剂预期效应和功能磁共振成像（fMRI）血氧水平依赖性活动。
上肢（手部和改良手臂） Fugl-Meyer 评估（cFMA）运动评分发现了显著的组×时间交互作用。实验组的 cFMA 评分改善程度大于对照组，cFMA 评分显著改善（3.41 ± 0.563 分差异，p = 0.018），表明从无活动到患侧肌肉的一些活动有了临床意义的改善。实验组的 cFMA 改善与 fMRI 侧化指数和患手肌电图活动的变化相关。两组的安慰剂预期评分相当。
将 BMI 训练添加到行为导向的物理治疗中，可以用于诱导无残留手指运动的慢性中风患者运动功能的功能性改善，并可能为中风神经康复开辟新的途径。
