Zanona Aristela de Freitas, Piscitelli Daniele, Seixas Valquiria Martins, Scipioni Kelly Regina Dias da Silva, Bastos Marina Siqueira Campos, de Sá Leticia Caroline Kaspchak, Monte-Silva Kátia, Bolivar Miburge, Solnik Stanislaw, De Souza Raphael Fabricio
Department of Occupational Therapy and Graduate Program in Applied Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Front Neurol. 2023 Jan 9;13:1041978. doi: 10.3389/fneur.2022.1041978. eCollection 2022.
BACKGROUND: We investigated the effects of brain-computer interface (BCI) combined with mental practice (MP) and occupational therapy (OT) on performance in activities of daily living (ADL) in stroke survivors. METHODS: Participants were randomized into two groups: experimental ( = 23, BCI controlling a hand exoskeleton combined with MP and OT) and control ( = 21, OT). Subjects were assessed with the functional independence measure (FIM), motor activity log (MAL), amount of use (MAL-AOM), and quality of movement (MAL-QOM). The box and blocks test (BBT) and the Jebsen hand functional test (JHFT) were used for the primary outcome of performance in ADL, while the Fugl-Meyer Assessment was used for the secondary outcome. Exoskeleton activation and the degree of motor imagery (measured as event-related desynchronization) were assessed in the experimental group. For the BCI, the EEG electrodes were placed on the regions of FC3, C3, CP3, FC4, C4, and CP4, according to the international 10-20 EEG system. The exoskeleton was placed on the affected hand. MP was based on functional tasks. OT consisted of ADL training, muscle mobilization, reaching tasks, manipulation and prehension, mirror therapy, and high-frequency therapeutic vibration. The protocol lasted 1 h, five times a week, for 2 weeks. RESULTS: There was a difference between baseline and post-intervention analysis for the experimental group in all evaluations: FIM ( = 0.001, = 0.56), MAL-AOM ( = 0.001, = 0.83), MAL-QOM ( = 0.006, = 0.84), BBT ( = 0.004, = 0.40), and JHFT ( = 0.001, = 0.45). Within the experimental group, post-intervention improvements were detected in the degree of motor imagery ( < 0.001) and the amount of exoskeleton activations ( < 0.001). For the control group, differences were detected for MAL-AOM ( = 0.001, = 0.72), MAL-QOM ( = 0.013, = 0.50), and BBT ( = 0.005, = 0.23). Notably, the effect sizes were larger for the experimental group. No differences were detected between groups at post-intervention. CONCLUSION: BCI combined with MP and OT is a promising tool for promoting sensorimotor recovery of the upper limb and functional independence in subacute post-stroke survivors.
背景：我们研究了脑机接口（BCI）结合心理练习（MP）和职业治疗（OT）对中风幸存者日常生活活动（ADL）表现的影响。 方法：参与者被随机分为两组：实验组（n = 23，BCI控制手部外骨骼结合MP和OT）和对照组（n = 21，OT）。受试者通过功能独立性测量（FIM）、运动活动日志（MAL）、使用量（MAL - AOM）和运动质量（MAL - QOM）进行评估。箱块测试（BBT）和杰布森手部功能测试（JHFT）用于ADL表现的主要结果，而Fugl - Meyer评估用于次要结果。在实验组中评估外骨骼激活和运动想象程度（以事件相关去同步化测量）。对于BCI，根据国际10 - 20脑电图系统，将脑电图电极放置在FC3、C3、CP3、FC4、C4和CP4区域。外骨骼放置在受影响的手上。MP基于功能任务。OT包括ADL训练、肌肉松动、伸手任务、操作和抓握、镜像治疗以及高频治疗振动。该方案持续1小时，每周5次，共2周。 结果：实验组在所有评估中的基线和干预后分析存在差异：FIM（p = 0.001，d = 0.56）、MAL - AOM（p = 0.001，d = 0.83）、MAL - QOM（p = 0.006，d = 0.84）、BBT（p = 0.004，d = 0.40）和JHFT（p = 0.001，d = 0.45）。在实验组中，干预后运动想象程度（p < 0.001）和外骨骼激活量（p < 0.001）有所改善。对于对照组，在MAL - AOM（p = 0.001，d = 0.72）、MAL - QOM（p = 0.013，d = 0.50）和BBT（p = 0.005，d = 0.23）方面检测到差异。值得注意的是，实验组的效应量更大。干预后两组之间未检测到差异。 结论：BCI结合MP和OT是促进亚急性中风后幸存者上肢感觉运动恢复和功能独立性的有前景的工具。
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