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Brain–machine interface in chronic stroke rehabilitation: A controlled study

Authors

  • Ander Ramos-Murguialday PhD,

    Corresponding author
    1. Health Technologies Department, Tecnalia, San Sebastian, Spain
    • Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Doris Broetz PT,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Massimiliano Rea PhD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Leonhard Läer MD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Özge Yilmaz MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Fabricio L. Brasil MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Giulia Liberati PhD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Marco R. Curado MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Eliana Garcia-Cossio MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Alexandros Vyziotis MD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Woosang Cho MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Manuel Agostini MSc,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Ernesto Soares PhD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Surjo Soekadar MD,

    1. Neurorehabilitation Section, Human Cortical Physiology and Stroke, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
    2. Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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  • Andrea Caria PhD,

    1. Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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  • Leonardo G. Cohen MD,

    1. Neurorehabilitation Section, Human Cortical Physiology and Stroke, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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  • Niels Birbaumer PhD

    Corresponding author
    1. San Camillo Hospital, Institute for Hospitalization and Scientific Care, Venice Lido, Italy
    • Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany
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Address correspondence to Dr Ramos-Murguialday or Dr Birbaumer, Institute of Medical Psychology and Behavioral Neurobiology and MEG Center, University of Tubingen, Garten str 29, 72074 Tübingen, Germany. E-mail: ander.ramos@med.uni-tuebingen.de or E-mail: niels.birbaumer@uni-tuebingen.de

Abstract

Objective

Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain–machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study.

Methods

Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo–expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level–dependent activity were assessed before and after intervention.

Results

A significant group × time interaction in upper limb (combined hand and modified arm) Fugl–Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo–expectancy scores were comparable for both groups.

Interpretation

The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation. ANN NEUROL 2013;74:100–108

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