脑机接口对脑卒中后上肢运动功能效果的Meta分析

doi:10.3969/j.issn.1006-9771.2021.07.005

Abstract

Abstract:

Objective To systematically evaluate the effect of brain-computer interface (BCI) on upper-limb motor function after stroke, and compare the effects under different interfaces.

Methods Randomized controlled trials (RCTs) about BCI for upper-limb motor function after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data and CBM, from inception to October, 2020. The quality of the trials was assessed and the data were extracted according to the Cochrane Handbook of Systematic Review. A meta-analysis was carried out with RevMan 5.3 and ADDIS 1.16.8.

Results Ultimately, 14 RCTs involving 504 patients were included. Meta-analysis showed that BCI could obviously improve the Fugl-Meyer Assessment-Upper Extremities (FMA-UE) score (MD = 6.81, 95%CI 1.51 to 12.11,P < 0.05), Action Research Arm Test score (MD = 7.68, 95%CI 0.49 to 14.88, P < 0.05) and modified Barthel Index score (MD = 8.91, 95%CI 5.57 to 12.25, P < 0.001) after stroke. Subgroup analysis showed that FMA-UE score could be improved by BCI for both more than four weeks (MD = 9.44, 95%CI 1.83 to 17.04, P < 0.05) and less than four weeks (MD = 5.18, 95%CI 2.84 to 7.51, P < 0.001). For the types of interface, the probabilities of the best effects from network meta-analysis ranked as electrical stimulator (P = 0.53), visual feedback (P = 0.41) and machine assistance (P = 0.06).

Conclusion BCI, especially with electrical stimulator interface, could obviously improve upper-limb motor function and activities of daily living for stroke patients.

Key words: stroke, brain-computer interface, upper limb, motor, meta-analysis

CLC Number:

R743.3[文献标识码]A

LI Ling-ling,YU Ying,JIA Yu-qi,HUANG Hai-liang. Effect of Brain-computer Interface on Upper-limb Motor Function after Stroke: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 765-773.

Figures/Tables 10

研究	国家	n (E/C)	年龄 (岁, E/C)	病程 (E/C)	干预措施		干预时间	干预周期	驱动设备	结局指标
研究	国家	n (E/C)	年龄 (岁, E/C)	病程 (E/C)	E	C	干预时间	干预周期	驱动设备	结局指标
Ang等2015^[13]	新加坡	11/14	(48.50±13.50)/(53.60±9.50)	(383.00±290.80) d/(234.70±183.80) d	BCI+常规康复训练	伪BCI+常规康复训练	90 min/d,3 d/周	4周	机器辅助设备	①
Biasiucci等2018^[14]	瑞士	14/13	(56.36±9.91)/(59.00±12.36)	(39.79±45.90)个月/(33.46±30.51)个月	BCI+常规康复训练	伪BCI+常规康复训练	60 min/d,2 d/周	5周	电刺激仪	①
Chen等2020^[15]	中国	7/7	(41.60±12.00)/(52.00±11.10)	(3.10±1.70)个月/(3.90±1.50)个月	BCI+常规康复训练	伪BCI+常规康复训练	3次/周	4周	机器辅助设备	①
Frolov等2017^[16]	俄罗斯	55/19	(56.93±12.94)/(59.08±12.01)	(8.35±6.85)个月/(7.28±9.61)个月	BCI+常规康复训练	伪BCI+常规康复训练	30 min/d,3 d/周	4周	机器辅助设备	①②
Kim等2016^[17]	美国	15/15	(59.07±8.07)/(59.93±9.79)	(8.27±1.98)个月/(7.80±1.78)个月	BCI+常规康复训练	常规康复训练	30 min/d,5 d/周	4周	电刺激仪	①④
Lee等2020^[18]	韩国	13/13	(55.15±11.57)/(58.30±9.19)	(7.46±1.61)个月/(8.30±1.97)个月	BCI+常规康复训练	伪BCI+常规康复训练	30 min/d,5 d/周	4周	电刺激仪	①③④
Mihara等2013^[19]	日本	10/10	(56.10±7.90)/(60.10±8.50)	(146.60±36.20) d/(123.40±38.30) d	BCI+常规康复训练	伪BCI+常规康复训练	20 min/d,3 d/周	2周	视觉反馈装置	①②
Pichiorri等2015^[20]	意大利	14/14	(64.10±8.40)/(59.60±12.70)	(2.70±1.70)个月/ (2.5±1.20)个月	BCI+常规康复训练	伪BCI+常规康复训练	30 min/d,3 d/周	4周	视觉反馈装置	①
任海等2020^[21]	中国	30/30	(41.77±8.65)/(40.70±8.15)	(32.85±4.99) d/ (33.85±3.73) d	BCI+常规康复训练	常规康复训练	40 min/d,5 d/周	4周	机器辅助设备	①③④
向宪文等2020^[22]	中国	47/47	(58.60±2.70)/(60.20±1.90)	(18.20±1.70) d/ (19.20±2.10) d	BCI+常规康复训练	常规康复训练	45 min/d,2周为1个疗程,疗程间休息3 d	7周	电刺激仪	①④
张洺华等2020^[23]	中国	15/15	(60.93±6.76)/(57.87±8.61)	(3.02±1.36)个月/(3.44±1.55)个月	BCI+常规康复训练	伪BCI+常规康复训练	20 min/d,5 d/周	8周	电刺激仪	①④
徐英等2018^[24]	中国	16/16	(72.43±8.56)/(76.81±9.57)	未提供	BCI+常规康复训练	伪BCI+常规康复训练	30 min/d,3 d/周	8周	电刺激仪	①④
李明芬等2012^[11]	中国	7/7	(66.29±4.89)/(66.00±6.30)	未提供	BCI+常规康复训练	常规康复训练	90 min/d,3 d/周	8周	电刺激仪	①②
梁思捷等2020^[10]	中国	15/15	(50.60±13.46)/(57.94±8.84)	(3.00±2.98)个月/(2.93±1.44)个月	BCI+常规康复训练	伪BCI+常规康复训练	30 min/d,5 d/周	4周	机器辅助设备	①④

References 40

[1]	王陇德, 刘建民, 杨弋, 等. 我国脑卒中防治仍面临巨大挑战—«中国脑卒中防治报告2018»概要[J]. 中国循环杂志, 2019, 34(2):105-119.
	WANG L D, LIU J M, YANG Y, et al. The prevention and treatment of stroke still face huge challenges: brief report on stroke prevention and treatment in China, 2018[J]. Chin Circ J, 2019, 34(2):105-119.
[2]	GHAZIANI E, COUPPÉ C, SIERSMA V, et al. Electrical somatosensory stimulation in early rehabilitation of arm paresis after stroke: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2018, 32(10):899-912. doi: 10.1177/1545968318799496
[3]	赵亚萍. 基于肌电图检查探讨脑卒中患者脊髓运动神经元及周围神经的状况[D]. 合肥:安徽医科大学, 2019.
	ZHAO Y P. Study on the status of spinal motor neurons and peripheral nerves in stroke patients based on electromyography[D]. Hefei: Anhui Medical University, 2019.
[4]	贾杰. "中枢-外周-中枢"闭环康复:脑卒中后手功能康复新理念[J]. 中国康复医学杂志, 2016, 31(11):1180-1182.
	JIA J. Central-peripheral-central closed-loop rehabilitation: a new concept of rehabilitation of hand function after stroke[J]. Chin J Rehabil Med, 2016, 31(11):1180-1182.
[5]	贾花萍, 赵俊龙. 脑机接口技术[M]. 北京: 科学出版社, 2016: 143-146.
	JIA H P, ZHAO J L. Brain-computer Interface Technology [M]. Beijing: Science Press, 2016: 143-146.
[6]	吴琼, 任诗媛, 乐赞, 等. 脑机接口综合康复训练对亚急性期脑卒中疗效的静息态功能磁共振研究[J]. 中国康复理论与实践, 2020, 26(1):77-84.
	WU Q, REN S Y, YUE Z, et al. Brain-computer interface and comprehensive training for stroke: a resting state functional magnetic resonance imaging study[J]. Chin J Rehabil Theory Pract, 2020, 26(1):77-84.
[7]	张桃, 杨帮华, 段凯文, 等. 基于运动想象脑机接口的手功能康复系统设计[J]. 中国康复理论与实践, 2017, 23(1):4-9.
	ZHANG T, YANG B H, DUAN K W, et al. Development of hand function rehabilitation system based on motor imagery brain-computer interface[J]. Chin J Rehabil Theory Pract, 2017, 23(1):4-9.
[8]	巫嘉陵, 高忠科. 脑机接口技术及其在神经科学中的应用[J]. 中国现代神经疾病杂志, 2021, 21(1):3-8.
	WU J L, GAO Z K. Brain-computer interface technology and its applications in neuroscience[J]. Chin J Contemp Neurol Neurosurg, 2021, 21(1):3-8.
[9]	LYUKMANOV R K, AZIATSKAYA G A, MOKIENKO O A, et al. Post-stroke rehabilitation training with a brain-computer interface: a clinical and neuropsychological study[J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2018, 118(8):43-51.
[10]	梁思捷, 朱玉连, 王卫宁, 等. 脑机接口技术在脑卒中患者上肢功能障碍康复中的应用[J]. 中国康复医学杂志, 2020, 35(2):185-188.
	LIANG S J, ZHU Y L, WANG W N, et al. Application of brain-computer interface technology in rehabilitation of upper limb dysfunction in stroke patients[J]. Chin J Rehabil Med, 2020, 35(2):185-188.
[11]	李明芬, 贾杰, 刘烨, 等. 基于运动想象的脑机接口康复训练对脑卒中患者上肢运动功能的影响[J]. 老年医学与保健, 2012, 18(6):347-352.
	LI M F, JIA J, LIU Y, et al. Effect of motor imagery-based brain computer interface rehabilitation training on upper limb motor function for stroke patients[J]. Geriatr Health Care, 2012, 18(6):347-352.
[12]	中华神经科学会, 中华神经外科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6):379-380.
	Chinese Society of Neurology, Chinese Neurosurgical Society. Diagnosis of Cerebral Vascular Diseases[J]. Chin J Neurol, 1996, 29(6):379-380.
[13]	ANG K K, CHUA K S, PHUA K S, et al. A randomized controlled trial of EEG-based motor imagery brain-computer interface robotic rehabilitation for stroke[J]. Clin EEG Neurosci, 2015, 46(4):310-320. doi: 10.1177/1550059414522229
[14]	BIASIUCCI A, LEEB R, ITURRATE I, et al. Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke[J]. Nat Commun, 2018, 9(1):2421. doi: 10.1038/s41467-018-04673-z
[15]	CHEN S G, CAO L, SHU X K, et al. Longitudinal electroencephalography analysis in subacute stroke patients during intervention of brain-computer interface with exoskeleton feedback[J]. Front Neurosci, 2020, 14:809. doi: 10.3389/fnins.2020.00809
[16]	FROLOV A A, MOKIENKO O, LYUKMANOV R, et al. Post-stroke rehabilitation training with a motor-imagery-based brain-computer interface (BCI)-controlled hand exoskeleton: a randomized controlled multicenter trial[J]. Front Neurosci, 2017, 11:400. doi: 10.3389/fnins.2017.00400
[17]	KIM T, KIM S, LEE B. Effects of action observational training plus brain-computer interface-based functional electrical stimulation on paretic arm motor recovery in patient with stroke: a randomized controlled trial[J]. Occup Ther Int, 2016, 23(1):39-47. doi: 10.1002/oti.1403
[18]	LEE S H, KIM S S, LEE B H. Action observation training and brain-computer interface controlled functional electrical stimulation enhance upper extremity performance and cortical activation in patients with stroke: a randomized controlled trial[J]. [ahead of print]. Physiother Theory Pract, 2020: 1-9. doi: 10.1080/09593985.2020.1831114.
[19]	MIHARA M, HATTORI N, HATAKENAKA M, et al. Near-infrared spectroscopy-mediated neurofeedback enhances efficacy of motor imagery-based training in poststroke victims: a pilot study[J]. Stroke, 2013, 44(4):1091-1098. doi: 10.1161/STROKEAHA.111.674507
[20]	PICHIORRI F, MORONE G, PETTI M, et al. Brain-computer interface boosts motor imagery practice during stroke recovery[J]. Ann Neurol, 2015, 77(5):851-865. doi: 10.1002/ana.24390
[21]	任海, 谢志明. 脑机接口技术在脑卒中偏瘫患者上肢运动功能康复治疗中的疗效观察[J]. 中国实用医药, 2020, 15(10):181-183.
	REN H, XIE Z M. Observation on efficacy of brain-computer interface technique on rehabilitation of upper limb motor function in hemiplegic stroke patients[J]. Chin Prac Med, 2020, 15(10):181-183.
[22]	向宪文, 朱家莹, 孙远标, 等. 脑机接口康复训练系统治疗缺血性脑卒中恢复期上肢功能障碍的临床研究[J]. 中国医学创新, 2020, 17(20):154-158.
	XIANG X W, ZHU J Y, SUN Y B, et al. Clinical study of brain computer interface rehabilitation training system in treatment of upper limb dysfunction during convalescence of ischemic stroke[J]. Chin Med Innov, 2020, 17(20):154-158.
[23]	张洺华. 脑机接口技术对脑卒中偏瘫患者上肢及手功能的影响[D]. 石家庄:河北师范大学, 2020.
	ZHANG M H. Effect of brain-computer interface technology on upper limb and hand function in stroke patients with hemiplegia[D]. Shijiazhuang: Hebei Normal University, 2020.
[24]	徐英, 吉艳云, 贾杰, 等. 脑-计算机接口结合功能性电刺激训练对老年脑卒中患者上肢功能和认知的疗效观察[J]. 中华老年心脑血管病杂志, 2018, 20(9):988-990.
	XU Y, JI Y Y, JIA J, et al. Effect of brain-computer interface combined with functional electrical stimulation training on upper limb function and cognition in elderly patients with stroke[J]. Chin J Geriatr Heart Brain Vessel Dis, 2018, 20(9):988-990.
[25]	BOCKBRADER M A, FRANCISCO G, LEE R, et al. Brain computer interfaces in rehabilitation medicine[J]. PM R, 2018, 10(9):233-243. doi: 10.1016/S1934-1482(18)30028-5
[26]	KHAN M A, DAS R, IVERSEN H K, et al. Review on motor imagery based BCI systems for upper limb post-stroke neurorehabilitation: from designing to application[J]. Comput Biol Med, 2020, 123:103843. doi: 10.1016/j.compbiomed.2020.103843
[27]	PICHIORRI F, MATTIA D. Brain-computer interfaces in neurologic rehabilitation practice[J]. Handb Clin Neurol, 2020, 168:101-116.
[28]	陈树耿, 贾杰. 脑机接口在脑卒中手功能康复中的应用进展[J]. 中国康复理论与实践, 2017, 23(1):23-26.
	CHEN S G, JIA J. Application of brain-computer interface in rehabilitation of hand function after stroke[J]. Chin J Rehabil Theory Pract, 2017, 23(1):23-26.
[29]	姜荣荣, 陈艳, 潘翠环. 脑卒中后上肢和手运动功能康复评定的研究进展[J]. 中国康复理论与实践, 2015, 21(10):1173-1177.
	JIANG R R, CHEN Y, PAN C H. Advance in assessment of upper limb and hand motor function in patients after stroke[J]. Chin J Rehabil Theory Pract, 2015, 21(10):1173-1177.
[30]	林淑芳, 徐颖, 叶晓倩, 等. 脑卒中上肢运动功能评价量表在康复中的应用[J]. 中国康复, 2015, 30(6):424-427.
	LIN S F, XU Y, YE X Q, et al. Application of upper limb motor function evaluation scale after stroke in rehabilitation[J]. Chin J Rehabil, 2015, 30(6):424-427.
[31]	陈善佳, 周小炫, 方云华, 等. 日常生活活动能力量表在脑卒中康复临床使用情况的调查[J]. 中国康复医学杂志, 2014, 29(11):1044-1049.
	CHEN S J, ZHOU X X, FANG Y H, et al. An investigation on the clinical application of activities of daily living scale in stroke rehabilitation in China[J]. Chin J Rehabil Med, 2014, 29(11):1044-1049.
[32]	KRUSE A, SUICA Z, TAEYMANS J, et al. Effect of brain-computer interface training based on non-invasive electroencephalography using motor imagery on functional recovery after stroke: a systematic review and meta-analysis[J]. BMC Neurol, 2020, 20(1):385. doi: 10.1186/s12883-020-01960-5
[33]	CERVERA M A, SOEKADAR S R, USHIBA J, et al. Brain-computer interfaces for post-stroke motor rehabilitation: a meta-analysis[J]. Ann Clin Transl Neurol, 2018, 5(5):651-663. doi: 10.1002/acn3.2018.5.issue-5
[34]	ANG K K, GUAN C, PHUA K S, et al. Brain-computer interface-based robotic end effector system for wrist and hand rehabilitation: results of a three-armed randomized controlled trial for chronic stroke[J]. Front Neuroeng, 2014, 7:30.
[35]	江滨. 脑卒中后并发症流行特征分析及对基层管理优化建议[J]. 中国全科医学, 2021, 24(12):1445-1453.
	JIANG B. Analysis of the epidemiological characteristics of post-stroke complications and suggestions for the optimization of grass-roots management in grass-roots management system[J]. Chin Gener Pract, 2021, 24(12):1445-1453.
[36]	LI M F, LIU Y, WU Y, et al. Neurophysiological substrates of stroke patients with motor imagery-based Brain-Computer Interface training[J]. Int J Neurosci, 2014, 124(6):403-415. doi: 10.3109/00207454.2013.850082
[37]	YOUNG B M, NIGOGOSYAN Z, WALTON L M, et al. Dose-response relationships using brain-computer interface technology impact stroke rehabilitation[J]. Front Hum Neurosci, 2015, 9:361. doi: 10.3389/fpsyg.2018.00361
[38]	JOVANOVIC L I, KAPADIA N, LO L, et al. Restoration of upper limb function after chronic severe hemiplegia: a case report on the feasibility of a brain-computer interface-triggered functional electrical stimulation therapy[J]. Am J Phys Med Rehabil, 2020, 99(3):35-40.
[39]	REMSIK A, YOUNG B, VERMILYEA R, et al. A review of the progression and future implications of brain-computer interface therapies for restoration of distal upper extremity motor function after stroke[J]. Expert Rev Med Devices, 2016, 13(5):445-454. doi: 10.1080/17434440.2016.1174572
[40]	MILOSEVIC M, MARQUEZ-CHIN C, MASANI K, et al. Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation[J]. Biomed Eng Online, 2020, 19(1):81. doi: 10.1186/s12938-020-00824-w

驱动设备	Rank 1	Rank 2	Rank 3	Rank 4
电刺激仪	0.53	0.41	0.06	0.00
机器辅助设备	0.06	0.28	0.52	0.15
视觉反馈装置	0.41	0.29	0.17	0.12
对照组	0.00	0.02	0.25	0.72

Effect of Brain-computer Interface on Upper-limb Motor Function after Stroke: A Meta-analysis

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 10

References 40

Related Articles 15

Metrics

Comments

Recommended 0

[1]	SONG Yiling, REN Yuanchun, ZHU Feilong, KUANG Dongqing, CAO Qingjiu, LIN Yang, WANG Fang. Characteristics and relationship between the development of gross motor skills and executive function in children with attention deficit hyperactivity disorder [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 1-9.
[2]	ZHOU Zhining, ZHOU Rong, XIAO Yanwen, WANG Bowen, LÜ Jiaojiao, LIU Yu. Effect of multi-target transcranial direct current stimulation on performance of working memory-postural control dual-task in healthy adults [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 21-28.
[3]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[4]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[5]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[6]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[7]	WEI Mengli, ZHONG Yaping, ZHOU Yiwen, GUI Huixian, GUAN Yeming, YU Tingting. Difference in bilateral lower limb muscle synergy mode for gait in patients after unilateral anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 95-104.
[8]	BI Xiaoyu, ZHU Xiaotong, ZHU Feilong, KUANG Dongqing, SONG Yiling, FAN Biyao, REN Yuanchun. Sex difference of fine motor skills of school-age children with attention deficit hyperactivity disorder [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1029-1034.
[9]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[10]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.
[11]	WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.
[12]	WEI Xiaowei, YANG Jian, WEI Chunyan, HE Qiling. Adapted physical education programs for psychomotor development in school settings for children with intellectual and developmental disabilities: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 910-918.
[13]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[14]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[15]	LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.