Combined action observation- and motor imagery-based brain computer interface (BCI) for stroke rehabilitation: a case report

DOI: https://doi.org/10.21203/rs.3.rs-610878/v1

Abstract

Introduction: Upper extremity impairment is a problem usually found in poststroke patients, and it is seldom completely improved even following conventional physical therapy. Motor imagery (MI) and action observation (AO) therapy are mental practices that may regain motor function in poststroke patients, especially when integrating them with brain-computer interface (BCI) technology. However, previous studies have always investigated the effects of an MI- or AO-based BCI for stroke rehabilitation separately. Therefore, in this study, we aimed to propose the effectiveness of a combined AO and MI (AOMI)-based BCI with functional electrical stimulation (FES) feedback to improve upper limb functions and alter brain activity patterns in chronic stroke patients.

Case presentation: A 53-year-old male who was 12 years post stroke was left hemiparesis and unable to produce any wrist and finger extension.

Intervention: The participant was given an AOMI-based BCI with FES feedback 3 sessions per week for 4 consecutive weeks, and he did not receive any conventional physical therapy during the intervention. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and active range of motion (AROM) of wrist extension were used as clinical assessments, and the laterality coefficient (LC) value was applied to explore the altered brain activity patterns affected by the intervention.

Outcomes: The FMA-UE score improved from 34 to 46 points, and the AROM of wrist extension was increased from 0 degrees to 20 degrees. LC values in the alpha band tended to be positive whereas LC values in the beta band seemed to be slightly negative after the intervention.

Conclusion: An AOMI-based BCI with FES feedback training may be a promising strategy that could improve motor function in poststroke patients; however, its efficacy should be studied in a larger population and compared to that of other therapeutic methods.

Trial registration: Thai Clinical Trial Registry: TCTR20200821002. Registered 17 August 2020, http://www.thaiclinicaltrials.org

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