Modulating brain plasticity in rehabilitation of stroke and other brain lesions

背景资料： 中风和创伤性脑损伤造成的残疾是成年人长期并发症的主要原因。没有普遍接受的治疗方法可用于治疗这些疾病，这些残疾的经济、个人、家庭和社会成本不可低估。来自不同实验室的初步数据表明，有可能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。该项目的目的是确定中风运动障碍的机制，并描述最有前途的技术，以提高这些患者的皮层可塑性，以促进功能恢复。 今年的发现： 在过去的一年里，我们继续进行了一项成功的国际合作调查，将脑机接口（BCI）用作中风后治疗干预的新工具。这项工作涉及一项随机试验，评估联合物理治疗和BCI训练对慢性中风患者严重运动缺陷功能恢复的长期影响（长达6个月）。 在试验开始时，患者在8周的时间内平均参加了大约18次治疗。 患者被随机分配到两组之一。 第一组接受训练，以调节称为EEG感觉运动节律的大脑活动的特定模式，已知这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EEG感觉运动节律的增加与通过外骨骼设备打开瘫痪的手有关，而减少则导致手闭合。 对于第二组患者，EEG感觉运动节律调制和外骨骼的动作之间没有偶然性。瘫痪的手由外骨骼按随机时间表操纵。 Fugyl Meyer临床评定量表评估的功能增益更大，在接受应急BCI培训的组中观察到。 共有30名患者在6个月时返回进行随访Fugyl-Meyer评估。在6个月时，接受真实的BCI训练的组与假手术组相比保持了显著更大的功能增益。 总之，这项工作是一个重要的第一次证明，BCI为基础的康复促进长期持久的改善慢性中风患者的运动功能，即使是严重的轻瘫，并代表了一个有前途的战略，在严重中风神经康复。

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.