title: Brain-machine interface in chronic stroke rehabilitation: a controlled study.
abstract: OBJECTIVE
  Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study.
  
  
  METHODS
  Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention.
  
  
  RESULTS
  A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups.
  
  
  CONCLUSIONS
  The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation.
authors.affiliation: Institute of Medical Psychology and Behavioral Neurobiology and Magnetoencephalography Center, University of Tübingen, Tübingen, Germany; Health Technologies Department, Tecnalia, San Sebastian, Spain.
authors.forename: Ander
authors.initials: A
authors.lastname: Ramos-Murguialday
authors.forename: Doris
authors.initials: D
authors.lastname: Broetz
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Rea
authors.forename: Leonhard
authors.initials: L
authors.lastname: Läer
authors.forename: Ozge
authors.initials: O
authors.lastname: Yilmaz
authors.forename: Fabricio L
authors.initials: FL
authors.lastname: Brasil
authors.forename: Giulia
authors.initials: G
authors.lastname: Liberati
authors.forename: Marco R
authors.initials: MR
authors.lastname: Curado
authors.forename: Eliana
authors.initials: E
authors.lastname: Garcia-Cossio
authors.forename: Alexandros
authors.initials: A
authors.lastname: Vyziotis
authors.forename: Woosang
authors.initials: W
authors.lastname: Cho
authors.forename: Manuel
authors.initials: M
authors.lastname: Agostini
authors.forename: Ernesto
authors.initials: E
authors.lastname: Soares
authors.forename: Surjo
authors.initials: S
authors.lastname: Soekadar
authors.forename: Andrea
authors.initials: A
authors.lastname: Caria
authors.forename: Leonardo G
authors.initials: LG
authors.lastname: Cohen
authors.forename: Niels
authors.initials: N
authors.lastname: Birbaumer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001132:Arm / Q000502:physiology; D001921:Brain / Q000098:blood supply / Q000502:physiology* / Q000503:physiopathology; D058256:Brain Waves; D062207:Brain-Computer Interfaces; D016022:Case-Control Studies; D002908:Chronic Disease; D004569:Electroencephalography; D004576:Electromyography; D005260:Female; D006225:Hand / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D055815:Young Adult