IEEE Trans Neural Syst Rehabil Eng. 2020 Nov;28(11):2525-2536. doi: 10.1109/TNSRE.2020.3027955. Epub 2020 Nov 6.
Brain-computer interface (BCI)-guided robot-assisted upper-limb training has been increasingly applied to stroke rehabilitation. However, the induced long-term neuroplasticity modulation still needs to be further characterized. This study investigated the functional reorganization and its structural base after BCI-guided robot-assisted training using resting-state fMRI, task-based fMRI, and diffusion tensor imaging (DTI) data. The clinical improvement and the neurological changes before, immediately after, and six months after 20-session BCI-guided robot hand training were explored in 14 chronic stroke subjects. The structural base of the induced functional reorganization and motor improvement were also investigated using DTI. Repeated measure ANOVA indicated long-term motor improvement was found (F[2, 26] = 6.367, p = 0.006). Significantly modulated functional connectivity (FC) was observed between ipsilesional motor regions (M1 and SMA) and some contralesional areas (SMA, PMd, SPL) in the seed-based analysis. Modulated FC with ipsilesional M1 was significantly correlated with motor function improvement (r = 0.6455, p = 0.0276). Besides, increased interhemispheric FC among the sensorimotor area from resting-state data and increased laterality index from task-based data together indicated the re-balance of the two hemispheres during the recovery. Multiple linear regression models suggested that both motor function improvement and the functional change between ipsilesional M1 and contralesional premotor area were significantly associated with the ipsilesional corticospinal tract integrity. The results in the current study provided solid support for stroke recovery mechanism in terms of interhemispheric interaction and its structural substrates, which could further enhance the understanding of BCI training in stroke rehabilitation. This study was registered at https://clinicaltrials.gov (NCT02323061).
脑-机接口（BCI）引导的机器人辅助上肢训练已越来越多地应用于中风康复。然而，其诱导的长期神经可塑性调节仍需进一步表征。本研究使用静息态 fMRI、任务态 fMRI 和弥散张量成像（DTI）数据，研究了 BCI 引导的机器人辅助训练后的功能重组及其结构基础。在 14 名慢性中风患者中，探索了 20 次 BCI 引导的机器人手部训练前后及 6 个月后的临床改善和神经变化。还使用 DTI 研究了诱导的功能重组和运动改善的结构基础。重复测量方差分析表明，长期运动改善明显（F[2,26] = 6.367，p = 0.006）。基于种子的分析显示，同侧运动区（M1 和 SMA）与一些对侧区（SMA、PMd、SPL）之间的功能连接（FC）发生了显著调节。同侧 M1 的调节 FC 与运动功能改善呈显著正相关（r = 0.6455，p = 0.0276）。此外，来自静息态数据的感觉运动区之间的半球间 FC 增加，以及来自任务态数据的侧化指数增加，共同表明在恢复过程中两个半球的平衡。多元线性回归模型表明，运动功能改善和同侧 M1 与对侧运动前区之间的功能变化都与同侧皮质脊髓束的完整性显著相关。本研究为大脑半球间相互作用及其结构基础在中风康复中的作用机制提供了坚实的支持，进一步增强了对中风康复中 BCI 训练的理解。本研究在 https://clinicaltrials.gov 注册（NCT02323061）。
