title: Proof of principle of a brain-computer interface approach to support poststroke arm rehabilitation in hospitalized patients: design, acceptability, and usability.
abstract: OBJECTIVE
  To evaluate the feasibility of brain-computer interface (BCI)-assisted motor imagery training to support hand/arm motor rehabilitation after stroke during hospitalization.
  
  
  METHODS
  Proof-of-principle study.
  
  
  METHODS
  Neurorehabilitation hospital.
  
  
  METHODS
  Convenience sample of patients (N=8) with new-onset arm plegia or paresis caused by unilateral stroke.
  
  
  METHODS
  The BCI-based intervention was administered as an "add-on" to usual care and lasted 4 weeks. Under the supervision of a therapist, patients were asked to practice motor imagery of their affected hand and received as a discrete feedback the movements of a "virtual" hand superimposed on their own. Such a BCI-based device was installed in a rehabilitation hospital ward.
  
  
  METHODS
  Following a user-centered design, we assessed system usability in terms of motivation, satisfaction (by means of visual analog scales), and workload (National Aeronautics and Space Administration-Task Load Index). The usability of the BCI-based system was also evaluated by 15 therapists who participated in a focus group.
  
  
  RESULTS
  All patients successfully accomplished the BCI training. Significant positive correlations were found between satisfaction and motivation (P=.001, r=.393). BCI performance correlated with interest (P=.027, r=.257) and motivation (P=.012, r=.289). During the focus group, professionals positively acknowledged the opportunity offered by BCI-assisted training to measure patients' adherence to rehabilitation.
  
  
  CONCLUSIONS
  An ecological BCI-based device to assist motor imagery practice was found to be feasible as an add-on intervention and tolerable by patients who were exposed to the system in the rehabilitation environment.
authors.affiliation: Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy; Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy. Electronic address: g.morone@hsantalucia.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morone
authors.affiliation: Experimental Neurorehabilitation Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Pisotta
authors.affiliation: Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Pichiorri
authors.affiliation: Institute of Psychology, University of Würzburg, Würzburg, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kleih
authors.affiliation: Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Paolucci
authors.affiliation: Experimental Neurorehabilitation Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Molinari
authors.affiliation: Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Italy.
authors.forename: Febo
authors.initials: F
authors.lastname: Cincotti
authors.affiliation: Institute of Psychology, University of Würzburg, Würzburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kübler
authors.affiliation: Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Mattia
mesh_terms: D062207:Brain-Computer Interfaces; D006801:Humans; D007297:Inpatients; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D034941:Upper Extremity
keywords: Brain-computer interfaces; Rehabilitation; Stroke