A Meta-Analysis: The Effect of Brain-computer Interface(BCI) on chi trên phục hồi chức năng after đột quỵ - đột quỵ Center

Introduction

vận động phục hồi chức năng after đột quỵ is now fast-growing, driven by other technological fields such as virtual and augmented reality (VR/AR), robotics, and invasive and non-invasive brain-computer interface (BCI). BCI can provide thời gian thực sensory phản hồi of EEG activity, enabling đột quỵ bệnh nhân to regulate their sensorimotor rhythms consciously. In typical noninvasive, EEG-based BCI, the user's vận động intention (vận động imagery or execution) is decoded from the brain's electrical activity in thời gian thực by extracting relevant features. The detection of chuyển động intention by BCI will trigger the corresponding sensory phản hồi to the user. This phản hồi can be in abstract form (such as a cursor moving on a computer screen) or in the form of concrete phản hồi (such as a visual representation of a participant's body parts on a virtual avatar, or superimposed directly on a participant physically) or somatosensory delivery via robotic, tactile, or thần kinh cơ kích thích điện (NMES) systems to reproduce intended movements, which has been shown to nâng cao vận động learning.

The brain-computer interface has begun to be used in phục hồi chức năng after đột quỵ. It aims to thúc đẩy neuroplasticity by adjusting or self-regulating neurophysiological activities, thereby improving the effect of phục hồi chức năng. However, there are still uncertainties about its actual lâm sàng hiệu quả. This article aims to quantify the hiệu quả of BCI training in chi trên phục hồi chức năng after đột quỵ by conducting a meta-analysis of existing randomized controlled trials (RCTs). Changes in chức năng vận động at the beginning and end of the intervention were reported in these RCTs. The investigators reviewed available reports from all RCTs using these techniques. They provided pre- and post-intervention dyskinesia scores for the experimental and kiểm soát groups, which included standard liệu pháp, robotic liệu pháp, kích thích điện, and vận động imagery without BCI.

Methods

MEDLINE, CENTRAL, PEDro, and other databases were used, and the literature was screened by checking the references of multiple review articles. Randomized controlled trials using BCI for sau đột quỵ vận động phục hồi chức năng were selected, and vận động disorder scores before and after intervention were provided. Summary effect sizes were calculated using the random-effects inverse variance method. Initially, 524 articles were found, and after removing duplicates, the titles and abstracts of 473 articles were screened. Finally, 26 articles corresponding to BCI lâm sàng trials were found, of which 9 studies involving a total of 235 đột quỵ survivors met the inclusion criteria for meta-analysis (randomized controlled trials with vận động performance as the kết quả index).

kết quả

In 6 BCI studies, vận động cải thiện, mainly quantified by upper extremity Fugl-Meyer assessment (FMA-UE), exceeded the minimal clinically important difference (MCID=5.25), while this cải thiện was achieved in only 3 kiểm soát groups. Overall, the standardized mean difference between BCI training and FMA-UE compared with the kiểm soát condition was 0.79 (95% CI: 0.37 to 1.20), within the range of moderate to large pooled effect sizes. Furthermore, several studies have shown that BCI induces functional and structural neuroplasticity at subclinical levels.

Conclusions

Brain-computer interface-based neurorehabilitation shows moderate to large effect size on chi trên chức năng vận động, which is superior to conventional phục hồi chức năng treatments such as vận động imagery, mirror liệu pháp, robot-assisted training, constraint-induced chuyển động liệu pháp, virtual reality liệu pháp, and tDCS. In addition to vận động kết quả, several studies have reported subclinical levels of functional and structural neuroplasticity induced by BCI, some of which correlate with improved vận động kết quả. More studies with larger sample sizes are needed to cải thiện the reliability of these kết quả.

Reference: Cervera MA, Soekadar SR, Ushiba J, et al. Brain-computer interfaces for sau đột quỵ vận động phục hồi chức năng: a meta-analysis. Ann Clin Transl Neurol. 2018 Mar 25;5(5):651-663.