A Brain Centered Neuroengineering Approach for Motor Recovery after Stroke: Combined rTMS and BCI Training

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PI: Bin HeProposal number: 1264782Overview: The long-term goal of the proposed project is to develop a novel brain-based neuroengineering approach to substantially improve motor recovery after stroke. Stroke is a sudden and devastating disease that arises from the occlusion of the cerebral vasculature. The estimated cost of stroke in the U.S. in 2008 is 34.3 billion dollars. The chronic nature of the disease creates a lasting impact in terms of disease burden on the health care system, and can result in decades of lost wages affecting both patients and their families. Among the manifestations of stroke with the highest functional impact on patient quality of life are those resulting in motor impairment. The project seeks to develop a brain-based strategy for motor recovery after stroke, rather than motor function based, by means of a novel neuroengineering approach combining brain-computer interface (BCI) and repetitive transcranial magnetic stimulation (rTMS). The central hypothesis is that, in comparison to traditional standard-of-care physical therapy, subjects receiving supplementary rTMS and BCI training will show greater functional improvement in hand motor ability over time as well as recovery of normal motor connectivity patterns. Novel engineering methods will be developed to accomplish the proposed goal. Aim 1. To evaluate the effects of BCI training on the process of motor recovery after stroke. The working hypothesis for this aim is that subjects receiving BCI training will demonstrate greater motor improvements than control subjects receiving standard-of-care therapy only. Aim 2. To investigate combined rTMS, applied in an inhibitory fashion to the contralesional hemisphere, with subsequent BCI training. The hypothesis for this aim is that subjects receiving this combined approach will show greater improvements in motor function than both subjects receiving BCI training alone and control subjects receiving standard-of-care therapy only. Aim 3. To investigate the neural correlates of motor recovery after stroke by performing EEG/fMRI neuroimaging and effective connectivity analysis. This aim will allow for objectively and quantitatively assessing motor recovery following BCI and BCI/rTMS protocols in addition to clinical motor function assessment. Intellectual Merits: The proposed project represents a novel neuroengineering approach to improve motor recovery after stroke by integrating neural interfacing and modulation. These proposed aims will lead to development of novel neuroengineering techniques and a better understanding of mechanisms associated with neural plasticity and motor functions. In particular, the proposed research will develop a novel virtual reality based BCI for stroke patients, novel methods for analyzing EEG spatio-temporal distributions following rTMS, and novel methods for multimodal identification of the neural correlates of motor recovery after stroke, rather than relying on motor output alone. Broader Impacts: a) Societal: The proposed research addresses a significant problem in neuroengineering to translate basic BCI research to potential clinical applications, aiding numerous patients with stroke. b) Enhancement of infrastructure for research and education: The proposed project is an integral part of the neural engineering initiative at the University of Minnesota. The proposed project will provide unique opportunities for interdisciplinary training of graduate students, as well as undergraduate students at the University of Minnesota and local high school students. Special attention will be paid to recruiting minority and female students into the project. c) Knowledge dissemination: The findings will be disseminated widely via scholarly publications, and to the scientific community and public.