title: A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.
abstract: Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent.
  
  
  
  The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis.
  
  
  
  Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score.
  
  
  
  After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy.
  
  
  
  Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Michiyuki
authors: M
authors: Kawakami
authors: Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors: Toshiyuki
authors: T
authors: Fujiwara
authors: Department of Biosciences and Informatics, School of Fundamental Science and Technology, Graduate School of Keio University, Kohoku, Yokohama, Kanagawa, Japan.
authors: Junichi
authors: J
authors: Ushiba
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Atsuko
authors: A
authors: Nishimoto
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Kaoru
authors: K
authors: Abe
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Kaoru
authors: K
authors: Honaga
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Atsuko
authors: A
authors: Nishimura
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Katsuhiro
authors: K
authors: Mizuno
authors: Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors: Mitsuhiko
authors: M
authors: Kodama
authors: Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors: Yoshihisa
authors: Y
authors: Masakado
authors: Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors: Meigen
authors: M
authors: Liu
mesh_terms: D000328:Adult; D062207:Brain-Computer Interfaces; D004599:Electric Stimulation Therapy / Q000379:methods*; D004569:Electroencephalography; D004576:Electromyography; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009469:Neuromuscular Junction / Q000502:physiology*; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D000075082:Proof of Concept Study; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
keywords: Brain-machine interface; rehabilitation; stroke; upper extremity