本研究得到广东省国家科学基金面上项目（No.2023A1515010586）、广州市临床特色技术建设项目（No.2023C-TS19）、广东省教育科学规划项目（No.2022GXJK299）、广州市卫生与计划生育总体指导项目（20221A011109、20231A011111）、2022年广州市高等学校教学质量与教学改革项目的支持 高校教学改革总体项目（No.2022JXGG088/02-408-2306040XM）， 2022年度广州医科大学学生创新能力提升计划项目（No.PX-66221494/02-408-2304-19062XM）， 2021年度校级教育科学规划项目（2021： NO.45）， 2023年度高水平大学一流本科专业建设资金（2022JXA009， 2022JXD001， 2022JXD003）/（02-408-2304-06XM）、广州市教育局大学科研项目（第202235384号）、广州医科大学2022年度本科教学质量与教学改革项目（2022年第33号）、广东省国家自然科学基金项目（第2021A1515012197号）、广州市及大学基金项目（第202102010100号）。

该项目获得广州医科大学第五附属医院医学伦理协会立项（批准编号：广州医科大学第五附属医院医学伦理协会批准。KY01-2021-05-01）于2021年8月19日。该试验于2021年8月19日在中国临床试验注册中心注册（注册号：ChiCTR2100050162）。所有患者均签署了知情同意书。
1. 招聘
<ol><li>纳入标准<ol><li>招募符合第四届全国脑血管病学学术会议制定的脑卒中诊断标准的患者;通过脑部计算机断层扫描或磁共振成像确诊脑卒中，病程≥ 6 个月;在 Brunnstrom 1-3 期中风导致单手功能障碍;蒙特利尔认知评估 （MoCA） ≥ 26;年龄从50岁到75岁不等;右撇子占上风;自愿签署知情同意书的。</li>
	</ol></li>
	<li>排除标准<ol><li>排除既往有上肢骨折、上肢畸形等病史的患者;其状况不稳定或在实验过程中发生变化，影响实验结果;因严重的心、肺、肝、肾等重要器官疾病无法完成实验的;严重认知功能障碍或失语症;患有严重精神障碍;服用降低癫痫发作阈值的药物;有任何可能受到经颅磁刺激 （TMS） 产生的磁场影响的植入装置或金属。</li>
	</ol></li>
</ol>2. MI-BCI培训
注：本研究选择基于运动图像的上肢手功能康复机器人。该装置包括脑电图（EEG）帽（图1A）、计算机终端（即控制接口; 图1B）、外部机械手（图1E）和23英寸计算机显示屏（图1C）。
<ol><li>科目准备<ol><li>解释培训的目的和方法，并注意这些内容。</li>
		<li>将 MI-BCI EEG 帽戴在被摄体上，以确保被摄体头部的 Cz 点与帽 9,10 的 Cz 点重合。被摄体的 Cz 点是头部中心的顶点。为了确认这一点，请检查耳珠线与穿过鼻子和眉毛中心的人体正中线的交点。根据国际10-20脑电定位系统11确定脑电帽的Cz点。</li>
		<li>保持耳朵从头帽的耳缝露出来，并调整下巴带以固定头帽。</li>
		<li>将 24 个蘸有生理盐水的电极插入脑电图帽的凹槽中，然后将 2 个参比电极夹入两个耳垂。 注意： 电极应保持湿润状态，不得滴落。如果电极太干燥，脑电信号采集过程就会受到影响。如果电极太湿，滴落的盐水可能会影响受试者的功能表现。</li>
		<li>作为操作人员，在训练过程中要注意脑电图的采集。如果存在小范围的脑电干扰，首先要考虑相应的电极是否出现干燥、缺水或其他与训练有关的情况。此时，应立即停止训练和脑电图采集，并在继续训练前适当润湿电极。</li>
		<li>如果脑电信号的干扰范围很广，首先要考虑参比电极是否脱落。此时，立即停止训练，并再次将参比电极夹在耳垂处。</li>
		<li>将机械手放在患者身上，调整到舒适的训练位置，以防止因过度收紧或滑倒而引起上肢前臂疼痛。</li>
	</ol></li>
	<li>软件操作<ol><li>打开训练软件MI-BCI上肢手功能康复机器人，点击 用户列表，输入患者信息，包括姓名、疾病名称、出生日期、患病日期、患侧位置等。</li>
		<li>将脑电信号的稳定性调整为没有明显的杂波。</li>
		<li>点击 静息脑电图 按钮，让患者根据语音和文字提示完成静息脑电图采集过程：请闭眼放松，请睁开眼睛。这持续 60 秒。</li>
		<li>点击 任务设置 按钮，设置任务难度和训练时长。根据患者的实际情况，从9级向上或向下设置初始训练难度，并将训练时长设置为30分钟。</li>
		<li>在训练过程中，MI-BCI系统会根据患者的表现自动调整任务难度。检查训练的难度，如所抓物体的大小所反映的那样;任务的难度越高，抓取的物体就越精细。</li>
		<li>单击 “任务脑电图” 按钮开始正式培训。患者侧屏幕显示：请闭上眼睛，放松5秒。</li>
		<li>5秒后，患者侧屏幕显示：请睁开眼睛，想象您的手张开/握拳，持续3秒。要求患者按照屏幕上的命令进行操作。</li>
		<li>患者侧的屏幕显示扣人心弦的视频/开场视频，以帮助患者在想象中模拟视频所展示的动作。要求患者执行这个持续 5 秒的运动想象任务。</li>
		<li>该系统提取患者运动想象的脑电信号，利用算法分析运动意图的评分，并将其显示在患者一侧的屏幕上。检查机器人反馈，该反馈将在 4 秒后显示。 注：MI-BCI系统采用的模型为FBCNet（多波段滤波+通道分离卷积+方差层+FC），用于提取特征并对EEG信号进行评分12。MI-BCI系统的阈值是基于大量的临床试验数据和核心脑电图算法确定的。阈值为 60 分。</li>
		<li>检查显示的电机意图。如果患者的运动意图≥ 60 分（阈值），则系统识别出已实现指定的动作。如果患者的移动意图< 60 分，并且系统确定患者无法执行指定的移动，请确保音频提示患者继续前进并且不会气馁，并且患者遵守这一点。</li>
		<li>在训练过程中，实时观察脑电波形。如出现异常情况，应及时暂停训练，待信号调整稳定后再重新开始训练。如果患者在训练过程中感到疼痛或不适，请停止训练并记录终止训练的原因。</li>
	</ol></li>
</ol>3. 临床评估
<ol><li>信息收集<ol><li>收集并记录被征者的基本个人信息，如姓名、性别、出生日期、受教育程度等。</li>
		<li>完成受试者病史的收集，如临床病史、用药史、个人病史等。</li>
	</ol></li>
	<li>运动功能评估<ol><li>评估中风受试者的上肢 Fugl-Meyer 评估 （FMA-UE）13 。 总分66分。分数越高，患者的功能表现越好。</li>
		<li>评估中风受试者的 Wolf 运动功能测试 （WMFT）14 。总分85分。分数越高，患者的功能表现越好。</li>
	</ol></li>
	<li>认知功能评估<ol><li>评估中风受试者的简易精神状态检查 （MMSE）15 。按受教育程度分，分为文盲≤17分、小学受教育程度≤20分、初中及以上文化水平≤24分。</li>
	</ol></li>
	<li>情绪功能评估<ol><li>评估中风受试者的汉密尔顿焦虑量表 （HAMA）16 。评分范围为：≥21，有明显的焦虑;≥14分，肯定有焦虑;而超过7分，可能有焦虑。小于 7 分表示没有焦虑症状。</li>
		<li>评估中风受试者的汉密尔顿抑郁量表 （HAMD）17 。7 分< 分表示平均分，7-17 分表示个体可能患有抑郁症，17-24 分表示个体可以诊断为抑郁症，>24 分表示个体患有严重抑郁症。</li>
	</ol></li>
</ol>4. fNIRS脑功能评估
对于本研究，将 10 个源和 12 个检测器放置在 fNIRS 测试头帽上，以对应于本研究中的 8 个感兴趣区域 （ROI），包括双侧背外侧前额叶皮层 （DLPFC）、背外侧启动皮层 （PMC）、背外侧初级运动皮层 （M1） 和背外侧初级感觉皮层 （S1; 图2）。
<ol><li>科目准备<ol><li>解释培训的目的和方法，并针对受试者进行说明。确保受试者理解实验内容，熟悉相关程序;这有助于提高患者的依从性。</li>
		<li>将fNIRS测试头帽戴在被摄体上，确定被摄体头部的Cz点，并确保其与头帽的Cz点重合，如步骤2.1.2所述。</li>
		<li>为受试者调整头帽，确保两只耳朵都从耳帽的耳缝露出来，耳帽的双侧耳缘自然贴合双侧乳突，耳帽的前缘自然贴合前额，后缘自然贴合枕骨后部。调整下巴带以固定帽。</li>
		<li>适当调整颚带的松紧度。如果太松，会导致实验过程中头帽移位，从而导致定位不准确，影响信号采集。如果太紧，会引起被摄体的不适，从而降低依从性，影响被摄体的功能表现。</li>
	</ol></li>
	<li>预收集和数据收集<ol><li>进入fNIRS控制软件，选择 实验对象，根据患者信息建立患者治疗档案。</li>
		<li>单击“ 预收集 ”按钮以校准信号。根据近红外功能脑成像系统显示的部位信号强度，通过调整头帽的光源或接收器，使其更靠近被摄体的头皮，提高部位的信号强度和稳定性。</li>
		<li>当系统将所有站点显示为绿色时，信号强度稳定。停止预收集，然后单击 自动增益 按钮对信号进行最终调整。 注意：在预收集过程中，近红外脑功能成像系统呈现不同的颜色来表示站点的信号强度。灰色代表低信号强度，黄色代表良好的信号强度，绿色代表优秀的信号强度，红色代表信号强度过强。</li>
		<li>单击 “开始 ”按钮以收集信号。观察并记录实验中的各种情况，如信号波动和电极接触不良。</li>
	</ol></li>
	<li>fNIRS-运动任务评估<ol><li>在fNIRS系统中选择 Motor Task 范例。</li>
		<li>将患者的上肢放在测试台上，并要求患者在实验前休息 10 秒。</li>
		<li>在实验过程中，要求患者按照运动节奏分三个块抓住受影响的手，每个块包括 30 秒的任务和 30 秒的休息。每个任务由 15 个试验组成，每个试验包括 1 秒抓握和 1 秒打开抓握。</li>
		<li>每次休息时，要求患者闭上眼睛休息。如果受试者无法抓住受影响的手，请要求受试者进行运动意象练习。测试持续 190 秒（图 3）。三个块全部完成后，结束任务，保存数据，导入到自建数据库中。</li>
	</ol></li>
	<li>fNIRS-认知任务评估（Stroop任务）<ol><li>运行行为研究软件并选择 认知任务 范式。选择患者治疗文件，然后选择“ 一致性检验”。</li>
		<li>要求受试者将健康的手放在键盘的按钮上，然后要求受试者在试验开始前休息 10 秒。执行三个块的一致性检验，每个块包括 60 秒的任务和 30 秒的休息。每个任务包括 10 个试验，每个试验包括 2000 毫秒的注视和 4000 毫秒的刺激反应，总持续时间为 280 秒（图 4）。<ol><li>当字段字体左侧显示左符号时，请尽快根据字符含义（即左）按下键盘上的←键。</li>
			<li>当字段网格左侧显示右符号时，请尽快根据字符的含义（即右）单击键盘上的→按钮。</li>
		</ol></li>
		<li>选择 不一致检验;该过程与一致性检验的过程相同。<ol><li>当字段字体左侧显示右符号时，请忽略字符含义，并尽快根据文本出现的位置（即左侧）按下键盘上的←按钮。</li>
			<li>当字段字体右侧显示左符号时，请忽略字符含义，并尽快根据文本的位置（即右）单击键盘上的→按钮。</li>
		</ol></li>
		<li>完成任务，保存数据，并导出到自建数据库中。</li>
	</ol></li>
</ol>5. 后处理
<ol><li>在治疗前进行临床功能评估和fNIRS脑功能评估的评估。在第 10次 培训课程结束后执行所有评估（有关详细信息，请参阅步骤 3.1 至 4.4）。</li>
</ol>6. 数据处理和分析
<ol><li>对患者的个人信息和临床评估量表数据进行汇总分析。</li>
	<li>使用商业软件对近红外数据进行预处理。消除干扰测试的时间间隔和运动伪影，选择带通滤光片（0.01-0.2 Hz）去除噪声，根据修正的Beer-Lambert定律计算氧合血红蛋白（HbO）和脱氧血红蛋白（HbR）的相对变化，并将光密度信号转换为血氧浓度信号。 注：与HbR相比，HbO对不同条件之间的变化更敏感，因此本研究方案仅使用HbO数据进行后续分析。</li>
	<li>选择血氧类型中的 HbO 作为分析数据。设置 GLM 设计矩阵，并在任务中选择任务阶段。单击 “估计 ”按钮，将已建立的设计矩阵与收集的数据拟合。</li>
	<li>使用建立的线性相关模型来计算每个 ROI 中的 beta 值。通过行为研究软件导出 Stroop 任务中的参数、准确率 （ACC） 和响应时间 （RT）。</li>
</ol>

通过运动意象脑机接口恢复中风后运动功能

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W., Gowland, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+Fugl-Meyer+assessment+for+testing+motor+performance+in+patients+following+stroke.">Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.</a> Physical Therapy. 73 (7), 447-454 (1993).</li><li>Martinez, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Reaching+Performance+Scale+for+2+Wolf+Motor+Function+Test+Items.">A Reaching Performance Scale for 2 Wolf Motor Function Test Items.</a> Archives of Physical Medicine and Rehabilitation. 101 (11), 2015-2026 (2020).</li><li>Dufouil, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Population+norms+for+the+MMSE+in+the+very+old:+estimates+based+on+longitudinal+data.+Mini-Mental+State+Examination.">Population norms for the MMSE in the very old: estimates based on longitudinal data. Mini-Mental State Examination.</a> Neurology. 55 (11), 1609-1613 (2000).</li><li>Thompson, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hamilton+Rating+Scale+for+Anxiety+(HAM-A).">Hamilton Rating Scale for Anxiety (HAM-A).</a> Occupational Medicine. 65 (7), 601 (2015).</li><li>Zimmerman, M., Martinez, J. H., Young, D., Chelminski, I., Dalrymple, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Severity+classification+on+the+Hamilton+Depression+Rating+Scale.">Severity classification on the Hamilton Depression Rating Scale.</a> Journal of Affective Disorders. 150 (2), 384-388 (2013).</li><li>Bai, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Different+Therapeutic+Effects+of+Transcranial+Direct+Current+Stimulation+on+Upper+and+Lower+Limb+Recovery+of+Stroke+Patients+with+Motor+Dysfunction:+A+Meta-Analysis.">Different Therapeutic Effects of Transcranial Direct Current Stimulation on Upper and Lower Limb Recovery of Stroke Patients with Motor Dysfunction: A Meta-Analysis.</a> Neural Plasticity. 2019, 1372138 (2019).</li><li>Dimyan, M. A., Cohen, L. 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N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stroke-related+motor+outcome+measures:+do+they+quantify+the+neurophysiological+aspects+of+upper+extremity+recovery.">Stroke-related motor outcome measures: do they quantify the neurophysiological aspects of upper extremity recovery.</a> Journal of Bodywork and Movement Therapies. 18 (3), 412-423 (2014).</li><li>Potter, S. M., El Hady, A., Fetz, E. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Closed-loop+neuroscience+and+neuroengineering.">Closed-loop neuroscience and neuroengineering.</a> Frontiers in Neural Circuits. 8, 115 (2014).</li><li>Nowak, D. A., Grefkes, C., Ameli, M., Fink, G. 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作者没有什么可透露的。

脑卒中后中重度上肢运动功能障碍的康复期长，恢复困难，一直是临床康复研究的重点18。传统的上肢康复训练多为简单的外周介入治疗或中枢介入治疗19.同时，由于中度和重度肢体功能障碍患者缺乏积极参与，主要采用被动治疗，康复效果较差20。因此，不断开发新的中风康复技术/策略具有重要意义21.MI-BCI作为一种无创康?...

An erratum was issued for:&#160;<a href="https://www.jove.com/t/65405">Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke</a>. The Authors section was updated from:
Yongchun Jiang1,2,3 
Junxiao Yin4 
Biyi Zhao1,3,5 
Yajie Zhang1,3 
Tingting Peng1,3 
Wanqi Zhuang1,3 
Siqing Wang1,3 
Siqi Huang1,3 
Meilian Zhong1,2,3 
Yanni Zhang1,3 
Guibing Tang1,3 
Bingchi Shen6 
Haining Ou1,3 
Yuxin Zheng2,3&#160; 
Qiang Lin2,3 
1Guangzhou Medical University 
2Department of Rehabilitation Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University 
3Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University 
4Clinical Medical College of Acupuncture and Rehabilitation, Guangzhou University of Traditional Chinese Medicine 
5School of Traditional Chinese Medicine, Jinan University 
6Department of Stomatology, Second Clinical Medical College, Dongguan Campus of Guangdong Medical University 
&#160;
to:
Yongchun Jiang1,2,3 
Junxiao Yin4 
Biyi Zhao1,3,5 
Yajie Zhang1,3 
Tingting Peng1,3 
Wanqi Zhuang1,3 
Siqing Wang1,3 
Siqi Huang1,3 
Meilian Zhong1,3 
Yanni Zhang1,3 
Guibing Tang1,3 
Bingchi Shen6 
Haining Ou1,3 
Yuxin Zheng2,3&#160; 
Qiang Lin2,3 
1Guangzhou Medical University 
2Department of Rehabilitation Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University 
3Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University 
4Clinical Medical College of Acupuncture and Rehabilitation, Guangzhou University of Traditional Chinese Medicine 
5School of Traditional Chinese Medicine, Jinan University 
6Department of Stomatology, Second Clinical Medical College, Dongguan Campus of Guangdong Medical University 
&#160;

An erratum was issued for:&#160;<a href="https://www.jove.com/t/65405">Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke</a>. The Authors section was updated.

Erratum: Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke

近85%的脑卒中患者存在运动功能障碍1，特别是由于中重度上肢运动功能障碍患者的康复效果有限，严重影响了患者独立日常生活的能力，一直是研究的重点和难点。非侵入性脑机接口 （BCI） 被称为中风2 后运动功能障碍康复的新兴治疗方法。脑机接口是将使用者或主体的感官知觉、意象、认知和思维直接转化为行动，不依赖周围神经或肌肉，在大脑和外部设备之间建立直接的沟通和控制通道3。目前，脑机接口用于临床康复的范式包括运动意象（MI）、稳态视觉诱发电位（SSVEP）和听觉诱发电位（AEP）P3004，其中最常用和方便的是运动意象脑机接口（MI-BCI）。心肌梗死是一种干预措施，它使用视觉/动觉运动图像来可视化运动任务（如手、手臂或脚的运动）的执行。一方面，先前的研究表明，心肌梗死期间相关运动皮层的激活与实际的运动执行相似5。另一方面，与其他范式不同，MI可以通过运动记忆激活特定的活动区域，而无需任何外部刺激来改善运动功能;这有利于在中风患者中实施，特别是当与听力障碍相结合时6.
此外，MI-BCI 已被证明对改善中风患者的运动功能障碍具有积极作用。Cheng等人报道，与简单的软性机器人手套干预相比，基于MI-BCI的软性机器人手套结合以日常生活活动为导向的任务，在干预6周后的慢性脑卒中患者中表现出更明显的功能改善和更持久的动觉体验。此外，它还能够引起对运动的感知7.此外，Ang 等人纳入了 21 名患有中度至重度上肢功能障碍的慢性中风患者进行随机干预。通过上肢 Fugl-Meyer 评估 （FMA-UE） 评估干预前后的临床功能。结果显示，与简单触觉旋钮（HK）机器人干预（HK组）和标准手臂治疗干预（SAT组）相比，基于MI-BCI干预的HK运动增益效果（BCI-HK组）明显优于其他两组8。然而，MI-BCI的具体操作仍需要规范的标准，必须充分认识神经重塑的机制，这限制了MI-BCI的临床应用和推广。因此，本研究通过展示MI-BCI对36岁男性脑卒中上肢运动功能障碍患者的干预过程，总结干预前后的功能结局变化和脑功能重塑，以展示MI-BCI的完整手术过程，为临床康复应用和机制研究提供思路和参考。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>MI-BCI</td>
			<td>Rui Han, China</td>
			<td>RuiHan Bangde</td>
			<td>NA</td>
		</tr>
		<tr>
			<td>E-Prime&#160;</td>
			<td></td>
			<td>version 3.0</td>
			<td>behavioral research software.</td>
		</tr>
		<tr>
			<td>fNIRS</td>
			<td>Hui Chuang, China</td>
			<td>NirSmart-500</td>
			<td>NA</td>
		</tr>
		<tr>
			<td>NirSpark</td>
			<td></td>
			<td></td>
			<td>preprocess near-infrared data</td>
		</tr>
	</tbody>
</table>

motor imagery brain-computer interface in rehabilitation of upper limb motor dysfunction after stroke

中度或重度上肢运动功能障碍患者脑卒中后康复效果较差，由于遇到的困难，一直是研究的重点。脑机接口（BCI）是脑神经科学研究中的热门前沿技术。它是指将使用者或主体的感官知觉、意象、认知和思维直接转化为动作，不依赖周围神经或肌肉，在大脑和外部设备之间建立直接的沟通和控制通道。运动意象脑机接口（MI-BCI）是康复作为一种非侵入性康复手段最常见的临床应用。先前的临床研究证实，MI-BCI对中风后患者的运动功能障碍有积极改善。然而，目前缺乏临床操作示范。为此，本文详细阐述了MI-BCI治疗脑卒中后中重度上肢功能障碍患者的治疗，并通过临床功能评估和脑功能评估结果展示了MI-BCI的干预效果，为临床康复应用和机制研究提供思路和参考。

Nearly 85% of stroke patients have motor dysfunction1, especially due to the limited rehabilitation effect of patients with moderate and severe upper limb motor dysfunction, which seriously affects patients' ability to live independent daily lives and has been the focus and difficulty of research. Non-invasive brain-computer interface (BCI) is known as an emerging treatment for rehabilitation of motor dysfunction after stroke2. BCI is the direct conversion of the sensory perception, imagery, cognition, and thinking of users or subjects into actions, without reliance on peripheral nerves or muscles, to establish direct communication and control channels between the brain and external devices3. At present, the paradigms of BCI for clinical rehabilitation include motor imagery (MI), steady-state visual evoked potentials (SSVEP), and auditory evoked potentials (AEP) P3004, of which the most commonly used and convenient is motor imagery brain-computer interface (MI-BCI). MI is an intervention that uses visual/kinesthetic motor imagery to visualize the execution of motor tasks (such as hand, arm, or foot movements). On the one hand, previous studies have demonstrated that activation of the associated motor cortex during MI is similar to actual motor execution5. On the other hand, unlike other paradigms, MI can activate a specific area of activity through motor memory without any external stimulus to improve motor function; this is conducive to implementation in stroke patients, especially when combined with hearing dysfunction6.
Moreover, MI-BCI has been shown to have a positive effect on improving motor dysfunction in stroke patients. Cheng et al. reported that compared with simple soft robotic glove intervention, the soft robotic glove based on MI-BCI combined with tasks oriented to daily life activities showed more obvious functional improvement and more lasting kinesthetic experience in chronic stroke patients after 6 weeks of intervention. Furthermore, it was also able to elicit the perception of motor movements7. Additionally, Ang et al. included 21 chronic stroke patients with moderate to severe upper limb dysfunction for randomized intervention. The clinical function was evaluated before and after intervention by the Fugl-Meyer assessment of upper extremity (FMA-UE). The results showed that, compared with simple haptic knob (HK) robot intervention (HK group) and standard arm therapy intervention (SAT group), the motion gain effect of HK based on MI-BCI intervention (BCI-HK group) was significantly better than that of the other two groups8. However, the specific operation of MI-BCI still requires normative standards, and the mechanism of neural remodeling must be fully understood, which limits the clinical application and promotion of MI-BCI. Therefore, by showing the intervention process of MI-BCI in a 36-year-old male stroke patient with upper limb motor dysfunction, this study will summarize the functional outcome changes and brain function remodeling before and after the intervention to demonstrate the complete operation process of MI-BCI and provide ideas and references for clinical rehabilitation application and mechanism research.

作者聚焦：使用运动意象脑机接口改善中风患者的运动和认知功能

运动意象脑机接口在脑卒中后上肢运动功能障碍康复中的应用

This study focus on the clinical application of MI-BCI in stroke patients with moderate to severe upper limb motor dysfunction. And it provides ideas and references for the standardized clinical operation and mechanism research by demonstrating the operation process and intervention effect of MI-BCI. MI-BCI has present a positive effect on improving motor dysfunction in stroke patients.However, more clinical researches of this field will be done in the future to more appropriate treatment protocols for this different level of function in stroke patients. In this study, functional near-infrared spectroscopy, fNIRS, was used to monitor the concentration changes of hemoglobin and the oxygenating hemoglobin in the cerebral cortex in real time under different stimulation task. Thus providing imaging evidence for the clinical effect of MI-BCI.We present a protocol to use MI-BCI training on stroke patients for upper limb motor rehabilitation. The scores of Fugi-Meyer assessment of upper extremity and Wolf Motor Function Test was both improved after MI-BCI treatment. Meanwhile, the fNIRS assessment also showed more activation of dorsolateral prefrontal cortex, primary motor cortex, and primary sensory cortex.The findings suggest potential improvement in motor and cognitive function in stroke patients upon MI-BCI intervention. Original upper limb rehabilitation intervention methods, either peripheral intervention or central intervention. Whereas MI-BCI is based on the closed-loop principle of center, peripheral and center, or combined central model with peripheral motor feedback.The closed-loop principle is more fit for the characteristic of central nervous system disease.

该研究介绍了一名 36 岁男性中风患者在 MI-BCI 干预前后的临床功能和脑功能重塑。脑出血后4个多月，影像学结果显示右额叶和右基底神经节区域-放射冠区域慢性出血。患者在脑出血恢复期间被诊断为左肢运动功能障碍。在医院进行MI-BCI的简单门诊治疗10天（30分钟/次/天），并在治疗前和治疗后10 d完成脑功能评估和临床功能评估（图5）。治疗前后临床评估结果为FMA-UE=12/14（...

Watch this Scientific Journal Video about Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke at JoVE.com

本研究旨在为脑卒中后上肢运动功能障碍运动意象脑机接口（MI-BCI）的标准临床操作提供重要参考。

The rehabilitation effect of patients with moderate or severe upper limb motor dysfunction after stroke is poor, which has been the focus of research ...

本研究重点介绍MI-BCI在中重度上肢运动功能障碍脑卒中患者中的临床应用。并通过展示MI-BCI的操作过程和干预效果，为规范化的临床操作和机制研究提供思路和参考。MI-BCI对改善脑卒中患者的运动功能障碍具有积极作用。然而，未来将进行更多该领域的临床研究，以针对中风患者这种不同功能水平的治疗方案进行更合适的治疗方案。本研究采用功能性近红外光谱（fNIRS）实时监测不同刺激任务下大脑皮层中血红蛋白和氧合血红蛋白的浓度变化。从而为MI-BCI的临床效果提供影像学证据。我们提出了一项方案，将 MI-BCI 训练用于中风患者的上肢运动康复。MI-BCI治疗后，上肢Fugi-Meyer评估和Wolf运动功能测试均有所提高。同时，fNIRS评估还显示背外侧前额叶皮层、初级运动皮层和初级感觉皮层的激活更多。研究结果表明，MI-BCI干预后，中风患者的运动和认知功能可能会得到改善。独创的上肢康复干预方法，可是外周介入或中枢介入。而MI-BCI则基于中心、外围和中心的闭环原理，或将中心模型与外围电机反馈相结合。闭环原理更适合中枢神经系统疾病的特点。

motor-imagery-brain-computer-interface-rehabilitation-upper-limb

Research

JoVE Journal

Neuroscience

Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke

841 次观看.  Guangzhou Medical University. 本研究重点介绍MI-BCI在中重度上肢运动功能障碍脑卒中患者中的临床应用。并通过展示MI-BCI的操作过程和干预效果，为规范化的临床操作和机制研究提供思路和参考。MI-BCI对改善脑卒中患者的运动功能障碍具有积极作用。然而，未来将进行更多该领域的临床研究，以针对中风患者这种不同功能水平的治疗方案进行更合适的治疗方案。本研究采用功能性近红外光谱（fNIRS?...

视频: 作者聚焦：使用运动意象脑机接口改善中风患者的运动和认知功能

The rehabilitation effect of patients with moderate or severe upper limb motor dysfunction after stroke is poor, which has been the focus of research owing to the difficulties encountered. Brain-computer interface (BCI) represents a hot frontier technology in brain neuroscience research. It refers to the direct conversion of the sensory perception, imagery, cognition, and thinking of users or subjects into actions, without reliance on peripheral nerves or muscles, to establish direct communication and control channels between the brain and external devices. Motor imagery brain-computer interface (MI-BCI) is the most common clinical application of rehabilitation as a non-invasive means of rehabilitation. Previous clinical studies have confirmed that MI-BCI positively improves motor dysfunction in patients after stroke. However, there is a lack of clinical operation demonstration. To that end, this study describes in detail the treatment of MI-BCI for patients with moderate and severe upper limb dysfunction after stroke and shows the intervention effect of MI-BCI through clinical function evaluation and brain function evaluation results, thereby providing ideas and references for clinical rehabilitation application and mechanism research.

The purpose of this study is to provide an important reference for the standard clinical operation of motor imagery brain-computer interface (MI-BCI) for upper limb motor dysfunction after stroke.

科研

神经科学

Training and Clinical Evaluation of Motor Imagery Brain-Computer Interface

Begin by explaining the training purpose and method to the patient. Put the MIBCI EEG cap on the patient ensuring that the Cz point of the cap coincides with that of the patient's head. Confirm the position of the EEG cap by checking the intersection point of the ear bead line and the human median line passing through the nose and eyebrow center.Keep the ears exposed from the ear seam of the head cap and adjust the chinstrap to fix the head cap. Insert 24 electrodes dipped in normal saline into the groove of the EEG cap and clip two reference electrodes into the two ear lobes. Put the manipulator on the patient and adjust it to a comfortable training position to prevent upper limb forearm pain.Then open the training software MIBCI upper limb hand function rehabilitation robot. Click the user list and enter the patient information, including name, disease name, date of birth, date of illness, and location of the affected side. Adjust the stability of the EEG signal to no obvious clutter and click the resting EEG button.Let the patient complete the resting EEG acquisition process according to the voice and text prompts. Click the task setting button and according to the situation of the patient, set the initial training difficulty upward or downward from level nine. Also set the training duration to 30 minutes.Click the task EEG button to start the formal training. Ask the patient to follow the onscreen text that asks them to close their eyes and relax for five seconds. After five seconds, ask the patient to open their eyes and follow the onscreen commands.The screen on the patient's side displays the gripping or opening video to assist the patient to imagine the actions. Ask the patient to perform the motion imagination task for five seconds. After another four seconds, check the motor intention.If the intention is less than 60 points, the system determines that the patient cannot perform the movement. During the training, the MIBCI system will automatically adjust the task difficulty according to the patient's performance. For course movements, the task difficulty is simple, making it easier for the patient to complete.Conversely, for fine movements, the task becomes more difficult, making it challenging for the patient to complete. If the patient has pain or discomfort during the training, stop the training and record the reason for termination. During the training, observe the EEG waveform in real time.If there is a small range of EEG disturbances, check the corresponding electrode for dryness. Stop the training and EEG acquisition immediately and properly wet the electrode before continuing. If the EEG signal has an extensive range of disturbance, check whether the reference electrode has fallen off.Stop the training immediately and clamp the reference electrode at the ear lobe again. After the test, evaluate the motor function by Fugl-Meyer Assessment of Upper Extremity out of a total score of 66. Also, evaluate the Wolf Motor Function Test out of a total score of 85.Perform cognitive function assessment by mini mental state examination on stroke subjects and divide the score according to the educational level. Also, evaluate the emotional function on patients using Hamilton Anxiety Scale and calculate the scores during the assessment process. Then, evaluate the emotion function using the Hamilton Depression Scale.MIBCI intervention was performed on a 36-year-old male stroke patient diagnosed with left limb motor dysfunction. Brain function and clinical function assessment before and 10 days after treatment showed improvement in FMAUE and WMFT scores.

运动意象脑机接口的训练和临床评估

fNIRS Motor Task and Cognitive Assessment Before and After MI-BCI Treatment

Perform fNIRS Motor Task Assessment by selecting the motor test paradigm in the fNIRS system. Place the patient's upper limb on the test table and ask the patient to rest for 10 seconds before the experiment. Ask the patient to follow the exercise rhythm, to grasp the effect hand in three blocks during the experiment.Each block includes 30 seconds task and 30 seconds rest. Each task consists of 15 trials. Each trial includes one second gripping and one second opening of the grasp.During each rest, ask the patients to close their eyes and rest. After all three blocks are complete, end the task, save the data, and import it to the self-built database. To perform cognitive task assessment by Stroop task, run behavioral research software and choose the Cognitive Task paradigm.Select the patient treatment files and then select Congruence test. Ask the patient to place their healthy hand on the button of the keyboard. Then ask the patient to rest for 10 seconds before the trial starts.Perform three blocks of the congruence test. Each block includes 60 seconds task and 30 seconds rest. Each task consists of 10 trials, each consisting of 2, 000 millisecond fixation, and 4, 000 millisecond stimulus response.When the left symbol is displayed on the left of the field font, press the left arrow button on the keyboard as soon as possible. Similarly, press the right arrow button when the right symbol is displayed on the field font. Next, select the Incongruence test.When the right symbol is displayed on the left of the field font, ask the patient to ignore the character meaning, and press the left arrow button on the keyboard. Similarly, press right arrow button when left symbol is displayed on the screen. Complete the task, save the data, and export it to the self-created database.In a 36-year-old male stroke patient diagnosed with left limb motor dysfunction, fNIRS evaluation showed that for the motor task paradigm, the beta value of RM1 was higher after MIBCI treatment. Similarly, the beta value of bilateral DLPFC for the congruence test was higher for the post-treatment than that for the pre-treatment. Also, the beta value of all ROIs for the incongruence test was higher after treatment with MIBCI.The Stroop cognitive paradigm assessment results showed that for the congruence test, the accuracy rate remained unchanged and the response time became shorter after treatment. For the incongruence test, the accuracy rate remained unchanged, and the response time was shorter after treatment.