Name: Author Spotlight: Using Motor Imagery Brain-Computer Interface to Improve Motor and Cognitive Function in Stroke Patients
Uploaded: 2023-09-01T14:40:00
Description: Watch this Scientific Journal Video about Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke at JoVE.com

This study was supported by the National Science Foundation of Guangdong Province (No.2023A1515010586), Guangzhou clinical characteristic technology construction project (2023C-TS19), Education Science Planning Project of Guangdong Province (No.2022GXJK299), the General Guidance Program of Guangzhou Municipal Health and Family Planning (20221A011109, 20231A011111), 2022 Guangzhou Higher Education Teaching Quality and Teaching Reform Project of Higher Education Teaching reform General project (No.2022JXGG088/02-408-2306040XM), 2022 Guangzhou Medical University Student Innovation Ability Improvement Plan project (No.PX-66221494/02-408-2304-19062XM), 2021 school-level education science planning project (2021: NO.45), 2023 First-class Undergraduate Major Construction Fund of high-level University (2022JXA009,&#160;2022JXD001, 2022JXD003)/(02-408-2304-06XM), Guangzhou Education Bureau university research project (No. 202235384), 2022 Undergraduate Teaching Quality and Teaching Reform Project of Guangzhou Medical University (2022 NO. 33), National Science Foundation of Guangdong Province (No. 2021A1515012197), and Guangzhou and University Foundation (No. 202102010100).

This project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University (approval No. KY01-2021-05-01) on August 19, 2021. The trial was registered in the Chinese Clinical Trials Registry (registration number: NO. ChiCTR2100050162) on August 19, 2021. All patients signed the informed consent form.
1. Recruitment
<ol>
	<li>Inclusion criteria
	<ol>
		<li>Recruit patients who meet the diagnostic criteria of stroke formulated ...

Restoring Post-Stroke Motor Function by Motor Imagery Brain-Computer Interface

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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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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immediate+and+long-term+effects+of+BCI-based+rehabilitation+of+the+upper+extremity+after+stroke:+a+systematic+review+and+meta-analysis.">Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis.</a> Journal of NeuroEngineering and Rehabilitation. 17 (1), 57 (2020).</li><li>Yang, W., 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=The+Effect+of+Brain-Computer+Interface+Training+on+Rehabilitation+of+Upper+Limb+Dysfunction+After+Stroke:+A+Meta-Analysis+of+Randomized+Controlled+Trials.">The Effect of Brain-Computer Interface Training on Rehabilitation of Upper Limb Dysfunction After Stroke: A Meta-Analysis of Randomized Controlled Trials.</a> Frontiers in Neuroscience. 15, 766879 (2021).</li><li>Pandian, S., Arya, K. 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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The rehabilitation period for moderate and severe upper limb motor dysfunction after stroke is long and the recovery is difficult, which has always been the focus of clinical rehabilitation research18. Traditional upper limb rehabilitation training is mostly simple peripheral intervention or central intervention19. Meanwhile, due to the lack of active participation of patients with moderate and severe limb dysfunction, passive treatment is mainly used, with poor rehabilitat...

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

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.

<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

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.

Author Spotlight: Using Motor Imagery Brain-Computer Interface to Improve Motor and Cognitive Function in Stroke Patients

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

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.

The study presents the clinical function and remodeling of brain function before and after MI-BCI intervention in a 36-year-old male stroke patient. More than 4 months after cerebral hemorrhage, the imaging results showed chronic bleeding focus in the right frontal lobe and the right basal ganglia region-radiative crown region. The patient was diagnosed with left limb motor dysfunction during convalescence from a cerebral hemorrhage. Simple outpatient treatment of MI-BCI was performed in the hospital for 10 days (30 min/...

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

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.

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