Modulating brain plasticity in rehabilitation of stroke and other brain lesions

背景： 中风和创伤性脑损伤导致的残疾是成人长期并发症的主要原因。目前还没有普遍接受的治疗方法来治疗这些疾病，这些残疾造成的经济、个人、家庭和社会代价不可低估。来自不同实验室的初步数据表明，通过药理学或大脑和体感刺激技术来调节受损大脑的可塑性过程是可能的。本项目的目的是确定卒中运动障碍的机制，并描述最有希望改善这些患者皮质可塑性以促进功能恢复的技术。 今年的调查结果： 在过去的一年里，我们继续了一项成功的国际合作调查，将脑机接口(BCI)作为中风后治疗干预的新工具。这项工作包括一项随机试验，评估联合物理治疗和BCI训练对慢性中风患者严重运动障碍的功能恢复的长期效果(长达6个月)。在试验开始时，患者在8周的时间里平均参加了大约18次治疗。患者被随机分配到两组之一。第一组受训来调节大脑活动的特定模式，称为脑电感觉运动节奏，众所周知，这种节奏与健康个体的运动功能有关。使用定制软件应用程序实时分析EEG数据。检测到的脑电感觉运动节律的增加与通过外骨骼装置打开瘫痪的手有关，而减少则导致手的关闭。对于第二组患者，脑电感觉运动节律调制和外骨骼动作之间没有关联。瘫痪的手由外骨骼按照随机的时间表进行操作.通过Fugyl Meyer临床评定量表评估，在接受临时BCI培训的组中观察到更大的功能收益。共有30名患者在6个月后返回进行Fugyl-Meyer随访评估。6个月后，与假手术组相比，接受真正BCI训练的组保持了显著更大的功能增长。总之，这项工作是一个重要的首次证明，基于脑-机接口的康复促进了慢性中风患者运动功能的长期改善，即使是严重瘫痪的患者，并且代表了一种在严重中风神经康复中很有前途的策略。

Background: Disability resulting from stroke and traumatic brain injury represent the main causes of long-term complications in adults. There are no universally accepted treatments available to treat these conditions and the financial, personal, familial and social cost of these disabilities cannot be underestimated. Preliminary data from different laboratories have shown that it is possible to modulate plastic processes in the lesioned brain via pharmacological, or brain and somatosensory stimulation techniques. The purpose of this project is to identify mechanisms of stroke motor disability and characterize the most promising techniques to improve cortical plasticity in these patients to enhance functional recovery. Findings this year: Over the past year, we continued a successful international collaboration investigation the use of brain-computer interfaces (BCIs) as novel tools for therapeutic intervention following stroke. The work involved a randomized trial evaluating the long-term effects (up to 6 months) of combined physical therapy and BCI training on functional recovery of severe motor deficits in chronic stroke patients. At the outset of the trial, patients participated in approximately 18 therapy sessions on average, over an 8-week period. Patients were randomly assigned to one of two groups. The first group trained to modulate specific patterns of brain activity called EEG sensorimotor rhythms, which are known to be linked to motor function in healthy individuals. A custom software application was used to analyze the EEG data in real-time. Detected increases in the EEG sensorimotor rhythm were linked to opening of the paralyzed hand via an exoskeleton device, while decreases caused closing of the hand. For a second group of patients, there was no contingency between EEG sensorimotor rhythm modulation and action of the exoskeleton. The paralyzed hand was manipulated by the exoskeleton on a randomized schedule. Greater functional gains, as assessed with the Fugyl Meyer clinical rating scale, were observed in the group receiving contingent BCI training. A total of 30 patients returned at 6 months for a follow-up Fugyl-Meyer assessment. At 6 months, the group receiving real BCI training maintained significantly greater functional gains compared with the sham group. In summary, this work was an important first demonstration that BCI-based rehabilitation promotes long-lasting improvements in motor function of chronic stroke patients, even with severe paresis, and represents a promising strategy in severe stroke neurorehabilitation.