脑机接口训练结合运动想象辅助反馈对改善慢性卒中患者上肢功能和神经可塑性的疗效：一项双盲、平行组、随机对照试验
Efficacy of brain-computer interface training with motor imagery-contingent feedback in improving upper limb function and neuroplasticity among persons with chronic stroke: a double-blinded, parallel-group, randomized controlled trial.
作者信息
Kim Myeong Sun, Park Hyunju, Kwon Ilho, An Kwang-Ok, Kim Hayeon, Park Gyulee, Hyung Wooseok, Im Chang-Hwan, Shin Joon-Ho
机构信息
Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
Department of Rehabilitative and Assistive Technology, Rehabilitation Research Institute, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
出版信息
J Neuroeng Rehabil. 2025 Jan 6;22(1):1. doi: 10.1186/s12984-024-01535-2.
BACKGROUND
Brain-computer interface (BCI) technology can enhance neural plasticity and motor recovery in persons with stroke. However, the effects of BCI training with motor imagery (MI)-contingent feedback versus MI-independent feedback remain unclear. This study aimed to investigate whether the contingent connection between MI-induced brain activity and feedback influences functional and neural plasticity outcomes. We hypothesized that BCI training, with MI-contingent feedback, would result in greater improvements in upper limb function and neural plasticity compared to BCI training, with MI-independent feedback.
METHODS
This randomized controlled trial included persons with chronic stroke who underwent BCI training involving functional electrical stimulation feedback on the affected wrist extensor. Primary outcomes included the Medical Research Council (MRC) scale score for muscle strength in the wrist extensor (MRC-WE) and active range of motion in wrist extension (AROM-WE). Resting-state electroencephalogram recordings were used to assess neural plasticity.
RESULTS
Compared to the MI-independent feedback BCI group, the MI-contingent feedback BCI group showed significantly greater improvements in MRC-WE scores (mean difference = 0.52, 95% CI = 0.03-1.00, p = 0.036) and demonstrated increased AROM-WE at 4 weeks post-intervention (p = 0.019). Enhanced functional connectivity in the affected hemisphere was observed in the MI-contingent feedback BCI group, correlating with MRC-WE and Fugl-Meyer assessment-distal scores. Improvements were also observed in the unaffected hemisphere's functional connectivity.
CONCLUSIONS
BCI training with MI-contingent feedback is more effective than MI-independent feedback in improving AROM-WE, MRC, and neural plasticity in individuals with chronic stroke. BCI technology could be a valuable addition to conventional rehabilitation for stroke survivors, enhancing recovery outcomes.
TRIAL REGISTRATION
CRIS (KCT0009013).
背景
脑机接口（BCI）技术可增强中风患者的神经可塑性和运动恢复。然而，基于运动想象（MI）的脑机接口训练与MI非相关反馈训练的效果仍不明确。本研究旨在探究MI诱发的大脑活动与反馈之间的关联是否会影响功能和神经可塑性结果。我们假设，与采用MI非相关反馈的BCI训练相比，采用MI相关反馈的BCI训练能使上肢功能和神经可塑性得到更大改善。
方法
本随机对照试验纳入了慢性中风患者，他们接受了涉及患侧腕伸肌功能性电刺激反馈的BCI训练。主要结局包括腕伸肌肌力的医学研究委员会（MRC）量表评分（MRC-WE）和腕伸展主动活动范围（AROM-WE）。静息态脑电图记录用于评估神经可塑性。
结果
与MI非相关反馈BCI组相比，MI相关反馈BCI组的MRC-WE评分有显著更大的改善（平均差异=0.52，95%CI=0.03-1.00，p=0.036），且在干预后4周时AROM-WE增加（p=0.019）。在MI相关反馈BCI组中观察到患侧半球功能连接增强，与MRC-WE和Fugl-Meyer评估-远端评分相关。在未受影响半球的功能连接方面也观察到改善。
结论
对于慢性中风患者，采用MI相关反馈的BCI训练在改善AROM-WE、MRC和神经可塑性方面比MI非相关反馈更有效。BCI技术可能是中风幸存者传统康复的一项有价值的补充，可增强恢复效果。
试验注册
CRIS（KCT0009013）。
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