A Meta-Analysis: The Effect of Brain-computer Interface(ICC) on Upper Membro Reabilitação after Acidente Vascular Cerebral - Acidente Vascular Cerebral Center

Introduction

Motor reabilitação after acidente vascular cerebral is now fast-growing, driven by other technological fields such as virtual and augmented reality (VR/AR), robótica, and invasive and non-invasive interface cérebro-computador (ICC). ICC pode fornecer real-time sensory feedback of EEG activity, enabling acidente vascular cerebral pacientes to regulate their sensorimotor rhythms consciously. In typical noninvasive, EEG-based ICC, the user's motor intention (motor imagery or execution) is decoded from the brain's electrical activity in real-time by extracting relevant features. The detection of movimento intention by ICC will trigger the corresponding sensory feedback to the user. This feedback pode be in abstract form (such as a cursor moving on a computer screen) or in the form of concrete feedback (such as a visual representation of a participant's body parts on a virtual avatar, or superimposed directly on a participant physically) or somatosensory delivery via robótico, tactile, or neuromuscular estimulação elétrica (NMES) systems to reproduce intended movements, which has been shown to enhance motor learning.

The interface cérebro-computador has begun to be usado in reabilitação after acidente vascular cerebral. It aims to promote neuroplasticity by adjusting or self-regulating neurophysiological activities, thereby improving the effect of reabilitação. However, there are still uncertainties about its actual clinical efficacy. This article aims to quantify the eficácia of ICC training in upper membro reabilitação after acidente vascular cerebral by conducting a meta-analysis of existing randomized controlled trials (RCTs). Changes in motor função at the beginning and end of the intervention were reported in these RCTs. The investigators reviewed available reports from all RCTs usando these techniques. They fornecido pre- and post-intervention dyskinesia scores for the experimental and control groups, which included standard terapia, robótico terapia, estimulação elétrica, and motor imagery without ICC.

Methods

MEDLINE, CENTRAL, PEDro, and other databases were usado, and the literature was screened by checking the references of multiple review articles. Randomized controlled trials usando ICC for post-acidente vascular cerebral motor reabilitação were selected, and motor disorder scores before and after intervention were fornecido. Summary effect sizes were calculated usando the random-effects inverse variance method. Initially, 524 articles were found, and after removing duplicates, the titles and abstracts of 473 articles were screened. Finally, 26 articles corresponding to ICC clinical trials were found, of which 9 studies involving a total of 235 acidente vascular cerebral survivors met the inclusion criteria for meta-analysis (randomized controlled trials with motor performance as the outcome index).

Results

In 6 ICC studies, motor melhoria, mainly quantified by upper extremity Fugl-Meyer assessment (FMA-UE), exceeded the minimal clinically important difference (MCID=5.25), while this melhoria was achieved in only 3 control groups. Overall, the standardized mean difference between ICC training and FMA-UE compared with the control condition was 0.79 (95% CI: 0.37 to 1.20), within the range of moderate to large pooled effect sizes. Furthermore, several studies have shown that ICC induces funcional and structural neuroplasticity at subclinical levels.

Conclusions

Interface Cérebro-Computador-based neurorehabilitation shows moderate to large effect size on upper membro motor função, which is superior to conventional reabilitação tratamentos such as motor imagery, mirror terapia, robô-assisted training, constraint-induced movimento terapia, virtual reality terapia, and tDCS. In addition to motor outcomes, several studies have reported subclinical levels of funcional and structural neuroplasticity induced by ICC, some of which correlate with melhorado motor outcomes. More studies with larger sample sizes are needed to melhorar the reliability of these results.

Reference: Cervera MA, Soekadar SR, Ushiba J, et al. Brain-computer interfaces for post-acidente vascular cerebral motor reabilitação: a meta-analysis. Ann Clin Transl Neurol. 2018 Mar 25;5(5):651-663.