A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke
A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke
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DOI：
10.1177/1550059414522229
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发表时间：
2015-10-01
影响因子：
2
通讯作者：
Guan, Cuntai
中科院分区：
文献类型：
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作者：
Ang, Kai Keng;Chua, Karen Sui Geok;Guan, Cuntai
基于脑电图（EEG）的运动想象（MI）脑机接口（BCI）技术有可能通过诱导活动依赖性大脑可塑性来恢复运动功能。本研究的目的是调查基于脑电图的 MI BCI 系统与 MIT-Manus 肩肘机器人反馈 (BCI-Manus) 相结合对患有上肢偏瘫的慢性中风受试者的疗效。在这项单盲、随机试验中，26 名偏瘫受试者（中风后运动恢复的 Fugl-Meyer 评估 [FMMA] 评分为 4-40；16 名男性；平均年龄为 51.4 岁；平均中风持续时间为 297.4 天）经过预筛选，能够使用 MI BCI，被随机分配接受 BCI-Manus 或 Manus 治疗，持续 18 小时，持续 4 周。使用第 0、2、4 和 12 周的上肢 FMMA 评分来测量疗效。使用修订后的大脑对称指数 (rBSI) 对分配到 BCI-Manus 的受试者的 ElEG 数据进行量化，并分析与 FMMA 评分改善的相关性。 11 名和 15 名受试者分别接受了 BCI-Manus 和 Manus 治疗。马努斯组的一名受试者退出了。两组在第 0、2、4 和 12 周时的平均 FMMA 总分均有所改善：BCI-Manus 为 26.3 +/- 10.3、27.4 +/- 12.0、30.8 +/- 13.8 和 31.5 +/- 13.5，BCI-Manus 为 26.6 +/- 18.9、29.9 +/- 20.6、32.9对于 Manus，+/- 21.4 和 33.9 +/- 20.2，无 组间差异 (P = .51)。在第 12 周，通过 BCI-Manus（11 人中的 7 人 [63.6%]）获得 FMMA 分数进一步提高的受试者数量多于 Manus（14 人中的 5 人 [35.7%]）。 rBSI 和 FMMA 分数改善之间存在负相关 (P = .044)。 BCI-Manus 疗法耐受性良好，且与不良事件无关。总之，BCI-Manus 疗法对于严重中风后偏瘫后的手臂康复是有效且安全的。尽管使用基于脑电图的 MI 触发的机器人反馈（136 次重复/会话）减少了手臂运动重复次数，但运动增益与强化机器人治疗（1,040 次重复/会话）所获得的效果相当。 rBSI 与运动改善的相关性表明，rBSI 可用作基于 BCI 的中风康复的预后指标。
Electroencephalography (EEG)-based motor imagery (MI) brain-computer interface (BCI) technology has the potential to restore motor function by inducing activity-dependent brain plasticity. The purpose of this study was to investigate the efficacy of an EEG-based MI BCI system coupled with MIT-Manus shoulder-elbow robotic feedback (BCI-Manus) for subjects with chronic stroke with upper-limb hemiparesis. In this single-blind, randomized trial, 26 hemiplegic subjects (Fugl-Meyer Assessment of Motor Recovery After Stroke [FMMA] score, 4-40; 16 men; mean age, 51.4 years; mean stroke duration, 297.4 days), prescreened with the ability to use the MI BCI, were randomly allocated to BCI-Manus or Manus therapy, lasting 18 hours over 4 weeks. Efficacy was measured using upper-extremity FMMA scores at weeks 0, 2, 4 and 12. ElEG data from subjects allocated to BCI-Manus were quantified using the revised brain symmetry index (rBSI) and analyzed for correlation with the improvements in FMMA score. Eleven and 15 subjects underwent BCI-Manus and Manus therapy, respectively. One subject in the Manus group dropped out. Mean total FMMA scores at weeks 0, 2, 4, and 12 weeks improved for both groups: 26.3 +/- 10.3, 27.4 +/- 12.0, 30.8 +/- 13.8, and 31.5 +/- 13.5 for BCI-Manus and 26.6 +/- 18.9, 29.9 +/- 20.6, 32.9 +/- 21.4, and 33.9 +/- 20.2 for Manus, with no intergroup differences (P = .51). More subjects attained further gains in FMMA scores at week 12 from BCI-Manus (7 of 11 [63.6%]) than Manus (5 of 14 [35.7%]). A negative correlation was found between the rBSI and FMMA score improvement (P = .044). BCI-Manus therapy was well tolerated and not associated with adverse events. In conclusion, BCI-Manus therapy is effective and safe for arm rehabilitation after severe poststroke hemiparesis. Motor gains were comparable to those attained with intensive robotic therapy (1,040 repetitions/session) despite reduced arm exercise repetitions using EEG-based MI-triggered robotic feedback (136 repetitions/session). The correlation of rBSI with motor improvements suggests that the rBSI can be used as a prognostic measure for BCI-based stroke rehabilitation.