title: Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke.
abstract: OBJECTIVE
  Brain computer interface technology is of great interest to researchers as a potential therapeutic measure for people with severe neurological disorders. The aim of this study was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using an A-B-A-B withdrawal single-subject design.
  
  
  METHODS
  A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity. In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related cortical potential was observed in the electroencephalogram.
  
  
  RESULTS
  The subject initially showed diffuse functional magnetic resonance imaging activation and small electro-encephalogram responses while attempting finger movement. Epoch A was associated with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone was observed.
  
  
  CONCLUSIONS
  These results indicate that self-directed training with a brain computer interface may induce activity- dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.
authors.affiliation: Department of Rehabilitation Medicine, Asahikawa Medical University, 078-8510 Asahikawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Mukaino
authors.forename: Takashi
authors.initials: T
authors.lastname: Ono
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Shindo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ota
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.forename: Meigen
authors.initials: M
authors.lastname: Liu
authors.forename: Junichi
authors.initials: J
authors.lastname: Ushiba
mesh_terms: D000328:Adult; D062207:Brain-Computer Interfaces; D002908:Chronic Disease; D004558:Electric Stimulation; D004576:Electromyography; D005385:Fingers / Q000503:physiopathology; D006429:Hemiplegia / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009068:Movement / Q000502:physiology; D020146:Putaminal Hemorrhage / Q000150:complications* / Q000175:diagnosis; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology