Literature sharing: Brain-computer Interface-Based Soft Robotic Glove Rehabilitation for Stroke

Background：Upper limb impairment is common in stroke and can have a devastating impact on the daily lives of stroke survivors. Conventional rehabilitation strategies targeting motor impairments in stroke survivors include the multidisciplinary treatments of physical therapy and occupational therapy. Recently, techniques such as constraint-induced movement therapy, mirror therapy (MT), and robot-assisted therapy utilise end effector systems. While such approaches have been reported to be efficacious in several studies, they largely require a minimum level of residual movement of the paretic limbs to carry out, and this excludes a large proportion of stroke patients, such as in the case of CIMT. Using brain-computer interface (BCI)-based motor imagery (MI) presents an alternative means of rehabilitation to address the issue faced by patients with negligible residual motor function.

Objective: This randomized controlled feasibility study investigates the ability for clinical application of the Brain-Computer Interface-based Soft Robotic Glove (BCI-SRG) incorporating activities of daily living (ADL)-oriented tasks for stroke rehabilitation.

Methods: Eleven recruited chronic stroke patients were randomized into the BCI-SRG or Soft Robotic Glove (SRG) group. Each group underwent a 120-minute intervention per session comprising 30-minute standard arm therapy and 90-minute experimental therapy (BCI-SRG or SRG). To perform ADL tasks, the BCI-SRG group used motor imagery-BCI and SRG, while the SRG group used SRG without motor imagery-BCI. Both groups received 18 sessions of intervention over 6 weeks. Fugl-Meyer Motor Assessment (FMA) and Action Research Arm Test (ARAT) scores were measured at baseline (week 0), post-intervention (week 6), and follow-ups (week 12 and 24). In total, 10/11 patients completed the study with 5 in each group and 1 dropped out.

Results: Though there were no significant intergroup differences for FMA and ARAT during 6-week intervention, the improvement of FMA and ARAT seemed to sustain beyond 6-week intervention for BCI-SRG group, as compared with SRG control. Incidentally, all BCI-SRG subjects reported a sense of vivid movement of the stroke-impaired upper limb and 3/5 had this phenomenon persisting beyond intervention while none of SRG did.

Conclusion: BCI-SRG suggested probable trends of sustained functional improvements with peculiar kinesthetic experience outlasting active intervention in chronic stroke despite the dire need for large-scale investigations to verify statistical significance. Adding BCI to soft robotic training for ADL-oriented stroke rehabilitation holds promise for sustained improvements and elicited perception of motor movements.

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Reference: Cheng N, Phua KS, Lai HS,et al. Brain-Computer Interface-Based Soft Robotic Glove Rehabilitation for Stroke. IEEE Trans Biomed Eng. 2020 Dec;67(12):3339-3351.