Combination of brain-computer interface training and goal-directed physical therapy in chronic stroke: a case report.
BACKGROUND
There is no accepted and efficient rehabilitation strategy to reduce focal impairments for patients with chronic stroke who lack residual movements.


METHODS
A 67-year-old hemiplegic patient with no active finger extension was trained with a brain-computer interface (BCI) combined with a specific daily life-oriented physiotherapy. The BCI used electrical brain activity (EEG) and magnetic brain activity (MEG) to drive an orthosis and a robot affixed to the patient's affected upper extremity, which enabled him to move the paralyzed arm and hand driven by voluntary modulation of micro-rhythm activity. In addition, the patient practiced goal-directed physiotherapy training. Over 1 year, he completed 3 training blocks. Arm motor function, gait capacities (using Fugl-Meyer Assessment, Wolf Motor Function Test, Modified Ashworth Scale, 10-m walk speed, and goal attainment score), and brain reorganization (functional MRI, MEG) were repeatedly assessed.


RESULTS
The ability of hand and arm movements as well as speed and safety of gait improved significantly (mean 46.6%). Improvement of motor function was associated with increased micro-oscillations in the ipsilesional motor cortex.


CONCLUSIONS
This proof-of-principle study suggests that the combination of BCI training with goal-directed, active physical therapy may improve the motor abilities of chronic stroke patients despite apparent initial paralysis.
Institute of Medical Psychology and Behavioral Neurobiology, MEG Center, University of Tübingen, Tübingen, Germany. doris.broetz@medizin.uni-tuebingen.de
Doris
D
Broetz
Christoph
C
Braun
Cornelia
C
Weber
Surjo R
SR
Soekadar
Andrea
A
Caria
Niels
N
Birbaumer
D000368:Aged; D002908:Chronic Disease; D003201:Computers / Q000639:trends*; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation / Q000639:trends*; D012371:Robotics / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D014584:User-Computer Interface