Ramirez-Nava Ana G, Mercado-Gutierrez Jorge A, Quinzaños-Fresnedo Jimena, Toledo-Peral Cinthya, Vega-Martinez Gabriel, Gutierrez Mario Ibrahin, Pacheco-Gallegos María Del Refugio, Hernández-Arenas Claudia, Gutiérrez-Martínez Josefina
Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Tlalpan, Mexico.
Medical Engineering Research Division, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Tlalpan, Mexico.
Front Neurol. 2023 Aug 17;14:1221160. doi: 10.3389/fneur.2023.1221160. eCollection 2023.
Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients.
A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney statistical tests (𝛼 = 0.05).
After training, we found statistically significant differences between groups for FMA ( = 0.012), ARAT ( < 0.001), and FIM ( = 0.025) scales.
It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity.
The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.
高达80%的中风后患者存在上肢运动障碍（ULMI），导致日常活动功能受限和失去独立性。使用传统治疗方法时，中风后上肢运动障碍很少能完全恢复。由脑机接口（BCI）控制的功能性电刺激疗法（FEST）是一种替代方法，即使对慢性中风后患者也可能诱导神经可塑性变化。这项工作的目的是评估基于P300的BCI控制的FEST干预对慢性中风后患者上肢运动障碍恢复的影响。
进行了一项非随机试点研究，包括14名患者，分为两组：BCI-FEST组和传统治疗组。在基线时以及进行20次治疗后，使用动作研究臂测试（ARAT）评估上肢功能，使用Fugl-Meyer评估（FMA）、功能独立性测量（FIM）评估性能损伤，并通过改良Ashworth量表（MAS）评估痉挛情况，使用卡方检验和Mann-Whitney统计检验（α = 0.05）比较获得的分数。
训练后，我们发现两组在FMA（ = 0.012）、ARAT（ < 0.001）和FIM（ = 0.025）量表上存在统计学显著差异。
研究表明，基于P300的BCI控制的FEST在改善中风后上肢运动障碍方面可能比传统治疗更有效，无论病程长短。
所提出的BCI-FEST干预的结果很有前景，即使对于那些通常被排除在新干预措施之外的最慢性中风后患者也是如此，他们通过传统治疗的预期恢复率非常低。未来有必要对更大样本的患者进行随机对照试验。
