title: Case report: post-stroke interventional BCI rehabilitation in an individual with preexisting sensorineural disability.
abstract: Therapies involving new technologies such as brain-computer interfaces (BCI) are being studied to determine their potential for interventional rehabilitation after acute events such as stroke produce lasting impairments. While studies have examined the use of BCI devices by individuals with disabilities, many such devices are intended to address a specific limitation and have been studied when this limitation or disability is present in isolation. Little is known about the therapeutic potential of these devices for individuals with multiple disabilities with an acquired impairment overlaid on a secondary long-standing disability. We describe a case in which a male patient with congenital deafness suffered a right pontine ischemic stroke, resulting in persistent weakness of his left hand and arm. This patient volunteer completed four baseline assessments beginning at 4 months after stroke onset and subsequently underwent 6 weeks of interventional rehabilitation therapy using a closed-loop neurofeedback BCI device with visual, functional electrical stimulation, and tongue stimulation feedback modalities. Additional assessments were conducted at the midpoint of therapy, upon completion of therapy, and 1 month after completing all BCI therapy. Anatomical and functional MRI scans were obtained at each assessment, along with behavioral measures including the Stroke Impact Scale (SIS) and the Action Research Arm Test (ARAT). Clinically significant improvements in behavioral measures were noted over the course of BCI therapy, with more than 10 point gains in both the ARAT scores and scores for the SIS hand function domain. Neuroimaging during finger tapping of the impaired hand also showed changes in brain activation patterns associated with BCI therapy. This case study demonstrates the potential for individuals who have preexisting disability or possible atypical brain organization to learn to use a BCI system that may confer some rehabilitative benefit.
authors.affiliation: Department of Radiology, University of Wisconsin-Madison Madison, WI, USA ; Neuroscience Training Program, University of Wisconsin-Madison Madison, WI, USA ; Medical Scientist Training Program, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Young
authors.affiliation: Department of Radiology, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Zack
authors.initials: Z
authors.lastname: Nigogosyan
authors.affiliation: Department of Radiology, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Veena A
authors.initials: VA
authors.lastname: Nair
authors.affiliation: Department of Biomedical Engineering, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Léo M
authors.initials: LM
authors.lastname: Walton
authors.affiliation: Department of Radiology, University of Wisconsin-Madison Madison, WI, USA ; Department of Biomedical Engineering, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Biomedical Engineering, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Tyler
authors.affiliation: Departments of Kinesiology and Medicine, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Dorothy F
authors.initials: DF
authors.lastname: Edwards
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Caldera
authors.affiliation: Department of Neurology, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Sattin
authors.affiliation: Neuroscience Training Program, University of Wisconsin-Madison Madison, WI, USA ; Department of Biomedical Engineering, University of Wisconsin-Madison Madison, WI, USA ; Department of Neurosurgery, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Williams
authors.affiliation: Department of Radiology, University of Wisconsin-Madison Madison, WI, USA ; Neuroscience Training Program, University of Wisconsin-Madison Madison, WI, USA ; Medical Scientist Training Program, University of Wisconsin-Madison Madison, WI, USA ; Department of Neurology, University of Wisconsin-Madison Madison, WI, USA ; Departments of Psychology and Psychiatry, University of Wisconsin-Madison Madison, WI, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Prabhakaran
keywords: BCI therapy; BCI-FES-TDU; UE motor rehabilitation; brain-computer interface; case study; disability; stroke rehabilitation