基于运动表象的脑机接口训练对亚急性期脑卒中患者手功能康复的效果

doi:10.3969/j.issn.1006-9771.2023.01.010

Abstract

Abstract:

Objective To observe the effect of brain-computer interface (BCI) training based on motor imagery on hand function in hemiplegic patients with subacute stroke.

Methods From June, 2020 to December, 2021, 40 patients with hemiplegia in subacute stroke from Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University were divided into control group (n = 20) and experimental group (n = 20) using random number table. Both groups accepted medication and routine comprehensive rehabilitation, while the control group accepted hand rehabilitation robot training, and the experimental group accepted the robot training using motor imagery-based BCI, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index, modified Ashworth scale, and measured integrated electromyogram of the superficial finger flexors, finger extensors and short thumb extensors of the affected forearm during maximum isometric voluntary contraction with surface electromyography.

Results Two patients in the control group and one in the experimental group dropped off. All the indexes improved in both groups after treatment (t > 2.322, Z > 2.631, P < 0.05), and they were better in the experimental group than in the control group (t > 2.227, Z > 2.078, P < 0.05), except the FMA-UE score of wrist.

Conclusion Motor imagery-based BCI training is more effective on hand function and activities of daily living in hemiplegic patients with subacute stroke.

Key words: stroke, motor imagery, brain-computer interface, hand function

CLC Number:

R743.3

LIU Mingyue, LI Zhe, CAO Yongsheng, HAO Daojian, SONG Xueyi. Effect of brain-computer interface training based on motor imagery on hand function for subacute stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 71-76.

Figures/Tables 9

References 38

[1]	STINEAR C M, LANG C E, ZEILER S, et al. Advances and challenges in stroke rehabilitation[J]. Lancet Neurol, 2020, 19(4): 348-360. doi: S1474-4422(19)30415-6 pmid: 32004440
[2]	WU S, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: S1474-4422(18)30500-3 pmid: 30878104
[3]	BEEBE J A, LANG C E. Active range of motion predicts upper extremity function 3 months after stroke[J]. Stroke, 2009, 40(5): 1772-1779. doi: 10.1161/STROKEAHA.108.536763 pmid: 19265051
[4]	NAKAYAMA H, JØRGENSEN H S, RAASCHOU H O, et al. Recovery of upper extremity function in stroke patients: the Copenhagen stroke study[J]. Arch Phys Med Rehabil, 1994, 75(4): 394-398. doi: 10.1016/0003-9993(94)90161-9
[5]	GAO X, WANG Y, CHEN X, et al. Interface, interaction, and intelligence in generalized brain-computer interfaces[J]. Trends Cogn Sci, 2021, 25(8): 671-684. doi: 10.1016/j.tics.2021.04.003 pmid: 34116918
[6]	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. Progress in the application of brain-computer interface in hand function rehabilitation after stroke[J]. Chin J Rehabil Theory Pract, 2017, 23(1): 23-26.
[7]	刘霞, 张萍, 李云杰, 等. 基于MI的脑机接口技术运用于脑卒中瘫痪患者脑功能激活和神经网络重塑的研究进展[J]. 中华神经科杂志, 2021, 54(10): 1089-1093.
	LIU X, ZHANG P, LI Y J, et al. Research progress of brain-computer interface technology based on motor imagery in brain function activation and neural network remodeling in stroke patients with paralysis[J]. Chin J Neurol, 2021, 54(10): 1089-1093.
[8]	BAI Z, FONG K, ZHANG J J, et al. Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis[J]. J Neuroeng Rehabil, 2020, 17(1): 57. doi: 10.1186/s12984-020-00686-2 pmid: 32334608
[9]	ANG K K, CHUA K S G, 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 pmid: 24756025
[10]	RAMOS-MURGUIALDAY A, BROETZ D, REA M, et al. Brain-machine interface in chronic stroke rehabilitation: a controlled study[J]. Ann Neurol, 2013, 74(1): 100-108. doi: 10.1002/ana.23879
[11]	BUCH E, WEBER C, COHEN L G, et al. Think to move: a neuromagnetic brain-computer interface (BCI) system for chronic stroke[J]. Stroke, 2008, 39(3): 910-917. doi: 10.1161/STROKEAHA.107.505313 pmid: 18258825
[12]	KWAKKEL G, VAN PEPPEN R, WAGENAAR R C, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis[J]. Stroke, 2004, 35(11): 2529-2539. doi: 10.1161/01.STR.0000143153.76460.7d pmid: 15472114
[13]	LI M, LIU Y, WU Y, et al. Neurophysiological substrates of stroke patients with motor imagery based brain-computer interface training[J]. Int J Neurosci, 2013, 124(6): 403-415. doi: 10.3109/00207454.2013.850082
[14]	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. A resting-state functional magnetic resonance study of the efficacy of comprehensive brain-computer interface rehabilitation training on the efficacy of subacute stage stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(1): 77-84.
[15]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[16]	NISHIMOTO A, KAWAKAMI M, FUJIWARA T, et al. Feasibility of task-specific brain-machine interface training for upper-extremity paralysis in patients with chronic hemiparetic stroke[J]. J Rehabil Med, 2018, 50(1): 52-58. doi: 10.2340/16501977-2275 pmid: 28949370
[17]	VIDAURRE C, BLANKERTZ B. Towards a cure for BCI illiteracy[J]. Brain Topogr, 2010, 23(2): 194-198. doi: 10.1007/s10548-009-0121-6 pmid: 19946737
[18]	梁嘉欣, 何龙龙, 黄国志, 等. 计算机运动反馈训练对脑卒中患者手功能康复的疗效观察[J]. 中国康复医学杂志, 2019, 34(4): 427-432.
	LIANG J X, HE L L, HUANG G Z, et al. Efficacy of computerized motor feedback training on hand function rehabilitation in stroke patients[J]. Chin J Rehabil Med, 2019, 34(4): 427-432.
[19]	WINTERS C, VAN WEGEN E E H, DAFFERTSHOFER A, et al. Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke[J]. Neurorehabil Neural Repair, 2015, 29(7): 614-622. doi: 10.1177/1545968314562115 pmid: 25505223
[20]	LEUNG S O C, CHAN C C H, SHAH S. Development of a Chinese version of the modified Barthel index: validity and reliability[J]. Clin Rehabil, 2007, 21(10): 912-922. doi: 10.1177/0269215507077286
[21]	PANDYAN A D, JOHNSON G R, PRICE C I, et al. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity[J]. Clin Rehabil, 1999, 13(5): 373-383. doi: 10.1191/026921599677595404 pmid: 10498344
[22]	HOOZEMANS M J M, VAN DIEËN J H. Prediction of handgrip forces using surface EMG of forearm muscles[J]. J Electromyogr Kinesiol, 2005, 15(4): 358-366. doi: 10.1016/j.jelekin.2004.09.001
[23]	SEKINE M, TAMURA T, YOSHIDA M, et al. A gait abnormality measure based on root mean square of trunk acceleration[J]. J Neuroeng Rehabil, 2013, 10: 118. doi: 10.1186/1743-0003-10-118 pmid: 24370075
[24]	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
[25]	HUMMEL F C, COHEN L G. Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke?[J]. Lancet Neurol, 2006, 5(8): 708-712. doi: 10.1016/S1474-4422(06)70525-7 pmid: 16857577
[26]	DE VICO F F, PICHIORRI F, MORONE G, et al. Multiscale topological properties of functional brain networks during motor imagery after stroke[J]. Neuroimage, 2013, 83: 438-449. doi: 10.1016/j.neuroimage.2013.06.039 pmid: 23791916
[27]	VALERO-CABRÉ A, AMENGUAL J L, STENGEL C, et al. Transcranial magnetic stimulation in basic and clinical neuroscience: a comprehensive review of fundamental principles and novel insights[J]. Neurosci Biobehav Rev, 2017, 83: 381-404. doi: 10.1016/j.neubiorev.2017.10.006
[28]	MADHOUN H Y, TAN B, FENG Y, et al. Task-based mirror therapy enhances the upper limb motor function in subacute stroke patients: a randomized control trial[J]. Eur J Phys Rehabil Med, 2020, 56(3): 265-271.
[29]	LI L M, UEHARA K, HANAKAWA T. The contribution of interindividual factors to variability of response in transcranial direct current stimulation studies[J]. Front Cell Neurosci, 2015, 9: 181. doi: 10.3389/fncel.2015.00181 pmid: 26029052
[30]	李芳, 安丙辰, 郑洁皎. 表面肌电图在脑卒中患者手神经肌肉功能评定中的应用[J]. 中国康复理论与实践, 2015, 21(3): 280-283.
	LI F, AN B C, ZHENG J J. Application of surface electromyography in the assessment of hand neuromuscular function in stroke patients[J]. Chin J Rehabil Theory Pract, 2015, 21(3): 280-283.
[31]	MUNOZ-NOVOA M, KRISTOFFERSEN M B, SUNNERHAGEN K S, et al. Upper limb stroke rehabilitation using surface electromyography: a systematic review and meta-analysis[J]. Front Hum Neurosci, 2022, 16: 697870.
[32]	李贞晶, 孟宪忠, 瞿昱, 等. 双侧手功能训练对卒中患者手功能及手屈伸肌群表面肌电的影响[J]. 中华物理医学与康复杂志, 2019, 41(8): 584-587.
	LI Z J, MENG X Z, QU Y, et al. Effects of bilateral hand function training on hand function and surface electromyography of hand flexor and extensor muscle groups in stroke patients[J]. Chin J Phys Med Rehabil, 2019, 41(8): 584-587.
[33]	刘远文, 付桢, 姜荣荣, 等. 康复机器手辅助下任务导向训练对脑卒中手功能的效果[J]. 中国康复理论与实践, 2017, 23(3): 338-344.
	LIU Y W, FU Z, JIANG R R, et al. Effectiveness of rehabilitation robotic-assisted task-oriented training on hand function in stroke[J]. Chin J Rehabil Theory Pract, 2017, 23(3): 338-344.
[34]	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 pmid: 29925890
[35]	SUN X, LI M, LI Q, et al. Poststroke cognitive impairment research progress on application of brain-computer interface[J]. Biomed Res Int, 2022, 2022: 9935192.
[36]	BANIQUED P D E, STANYER E C, AWAIS M, et al. Brain-computer interface robotics for hand rehabilitation after stroke: a systematic review[J]. J Neuroeng Rehabil, 2021, 18(1): 15. doi: 10.1186/s12984-021-00820-8 pmid: 33485365
[37]	MRACHACZ-KERSTING N, JIANG N, STEVENSON A J T, et al. Efficient neuroplasticity induction in chronic stroke patients by an associative brain-computer interface[J]. J Neurophysiol, 2016, 115(3): 1410-1421. doi: 10.1152/jn.00918.2015
[38]	REMSIK A B, WILLIAMS L, GJINI K, et al. Ipsilesional mu rhythm desynchronization and changes in motor behavior following post stroke BCI intervention for motor rehabilitation[J]. Front Neurosci, 2019, 13: 53. doi: 10.3389/fnins.2019.00053

组别	n	性别 (男/女)/n	年龄/岁	病程/d	偏瘫侧 (左/右)/n	卒中类型 (梗死/出血)/n	MMSE
对照组	18	10/8	52.89±13.07	90.28±52.15	7/11	8/10	26.17±1.25
试验组	19	15/4	51.26±11.06	98.26±48.25	10/9	5/14	26.53±1.65
χ²/t值		0.650	0.409	-0.484	0.703	1.333	-0.746
P值		0.420	0.685	0.632	0.402	0.248	0.461

组别	n	治疗前	治疗后	t值	P值
对照组	18	23.94±6.95	27.22±8.31	2.322	0.026
试验组	19	25.37±9.27	33.58±8.47	2.850	0.007
t值		0.529	2.304
P值		0.600	0.027

组别	n	治疗前	治疗后	Z值	P值
对照组	18	3.00(2.00, 4.00)	5.00(4.50, 6.25)	3.596	< 0.001
试验组	19	3.00(3.00, 4.00)	5.00(4.50, 6.25)	3.752	< 0.001
Z值		0.818	1.828
P值		0.443	0.075

组别	n	治疗前	治疗后	Z值	P值
对照组	18	4.00(3.00, 6.00)	7.00(5.50, 8.00)	3.666	< 0.001
试验组	19	4.00(3.00, 6.00)	8.00(7.00, 10.00)	3.860	< 0.001
Z值		0.492	2.139
P值		0.641	0.034

组别	n	治疗前	治疗后	t值	P值
对照组	18	32.50±12.16	45.56±16.08	6.200	< 0.001
试验组	19	34.73±9.05	58.16±12.27	10.346	< 0.001
t值		0.637	2.689
P值		0.528	0.011

Effect of brain-computer interface training based on motor imagery on hand function for subacute stroke patients

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组别	n	治疗前	治疗后	Z值	P值
对照组	18	2.00(1.50, 2.00)	1.50(1.50, 2.00)	2.631	0.009
试验组	19	1.50(1.00, 1.50)	1.00(1.00, 1.50)	3.852	< 0.001
Z值		1.201	2.078
P值		0.245	0.039

组别	n	治疗前	治疗后	Z值	P值
对照组	18	35.16(32.15, 41.23)	45.88(42.18, 59.40)	3.724	< 0.001
试验组	19	35.46(30.45, 43.26)	54.03(45.15, 63.42)	3.823	< 0.001
Z值		0.547	2.335
P值		0.599	0.020

组别	n	治疗前	治疗后	t值	P值
对照组	18	30.44±8.55	40.17±9.21	3.285	0.002
试验组	19	31.05±9.21	46.38±7.72	5.560	< 0.001
t值		0.208	2.227
P值		0.836	0.033

组别	n	治疗前	治疗后	t值	P值
对照组	18	31.17±9.41	40.39±9.88	11.987	< 0.001
试验组	19	32.74±7.04	47.74±6.22	12.259	< 0.001
t值		0.577	2.724
P值		0.568	0.010

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