A Meta-Analysis: The Effect of Brain-computer Interface(BCI) on 上 肢体 康复 after 卒中 - 卒中 中心 - 司羿 智能的

Introduction

运动 康复 after 卒中 is now fast-growing, driven by other technological fields such as virtual and augmented reality (VR/AR), 机器人技术, and invasive and non-invasive 脑机接口 (BCI). BCI can provide real-time 感觉的 feedback of EEG 活动, enabling 卒中 患者 to regulate their sensorimotor rhythms consciously. In typical noninvasive, EEG-based BCI, the user's 运动 intention (运动 imagery or execution) is decoded from the brain's electrical 活动 in real-time by extracting relevant features. The detection of motion intention by BCI will trigger the corresponding 感觉的 feedback to the user. This feedback can be in abstract 形成 (such as a cursor moving on a computer screen) or in the 形成 of concrete feedback (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 neuromuscular electrical stimulation (NMES) systems to reproduce intended movements, which has been shown to enhance 运动 learning.

The 脑机接口 has begun to be used in 康复 after 卒中. It aims to promote neuroplasticity by adjusting or self-regulating neurophysiological activities, thereby improving the effect of 康复. However, there are still uncertainties about its actual 临床的 efficacy. This article aims to quantify the effectiveness of BCI training in 上 肢体 康复 after 卒中 by conducting a meta-analysis of existing randomized controlled trials (RCTs). Changes in 运动 功能 at the beginning and end of the intervention were reported in these RCTs. The investigators reviewed available reports from 所有的 RCTs using these techniques. They provided pre- and post-intervention dyskinesia scores for the experimental and control groups, which included standard 治疗, robotic 治疗, electrical stimulation, and 运动 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 post-卒中 运动 康复 were selected, and 运动 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 临床的 trials were found, of which 9 studies involving a total of 235 卒中 survivors met the inclusion criteria for meta-analysis (randomized controlled trials with 运动 performance as the outcome index).

Results

In 6 BCI studies, 运动 improvement, mainly quantified by 上 extremity Fugl-Meyer assessment (FMA-UE), exceeded the minimal clinically 重要的 difference (MCID=5.25), while this improvement was achieved in only 3 control groups. Overall, the standardized mean difference between BCI training and FMA-UE compared with the control 状况 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

脑机接口-based 神经康复 shows moderate to large effect size on 上 肢体 运动 功能, which is superior to conventional 康复 treatments such as 运动 imagery, mirror 治疗, 机器人-assisted training, constraint-induced movement 治疗, virtual reality 治疗, and tDCS. In addition to 运动 outcomes, several studies have reported subclinical levels of functional and structural neuroplasticity induced by BCI, some of which correlate with improved 运动 outcomes. More studies with larger sample sizes are needed to improve the reliability of these results.

Reference: Cervera MA, Soekadar SR, Ushiba J, et al. 脑机接口s for post-卒中 运动 康复: a meta-analysis. Ann Clin Transl Neurol. 2018 Mar 25;5(5):651-663.