A Randomized Controlled Study Of The Short-term Efficacy Of Brain-computer Interface Training With Visual And Kinesthetic Feedback On Cognitive,Psychological And Limb Movements In Patients With Convalescent Stroke Hemiplegia

Objective: To investigate the short-term effects of brain-computer interface(BCI)motor imagination(MI)based on both visual and kinesthetic feedback on cognitive,psychological,limb movement and brain function in patients with convalescent stroke hemiplegia.Methods: Ninety convalescent stroke patients with hemiplegia were randomly divided into conventional exercise rehabilitation(Control),MI(routine exercise rehabilitation + routine MI)and BCI(routine exercise rehabilitation + BCI-based MI training)groups.Patients in MI and BCI groups imagined swimming with upper limbs and cycling with lower limbs.All participants were treated for 12 to 14 days,6days a week.Performance monitoring of BCI equipment: statistics(1)focused motion state ratio(MSP);(2)Effective training revolutions(ETR).Functional assessment before and after intervention:(1)Brief Mental State Examination Scale(MMSE): To evaluate patients’ cognitive and intelligence status.(2)Hamilton Depression Scale(HAMD): To assess the patients’ mental state.(3)EQ-5D: Patient self-health assessment.(4)Maximum expiratory pressure and maximum inspiratory pressure: To evaluate the strength of respiratory muscle.(5)Motor function: Fugl-Meyer scale(including FMA-UE and FMA-LE),6min walking distance(m)and modified Barthel index(MBI)were used to evaluate upper and lower limb movement and daily living ability.(6)Brain function: Transcranial magnetic stimulation(TMS)was used to detect the latency and amplitude of non-focal brain motor evoked potential(MEP).Results:(1)Performance of BCI equipment: the MSP and ETR of upper and lower limb training were 57.33±28.05/60.91±26.05(%)and 33.22± 12.88/19.09 ±6.95(r/min),respectively.There was no adverse reaction in the BCI group.(2)After intervention,there were no significant differences in MEP amplitude and maximum expiratory pressure in the Control group,MI group and BCI group compared with before intervention(P>0.05),the other items in the three groups were significantly improved compared with before intervention(P<0.05).(3)Difference before and after intervention:(1)No significant difference was found between MI group and Control group(P>0.05);(2)Except for the maximum expiratory pressure,the BCI group was the largest among the three groups,and the BCI group of MMSE,HAMD,FMA-UE and FMA-LE had significant differences with the Control group and MI group(P<0.05),the latency of MEP was significantly different between BCI group and MI group(P<0.05).Conclusion: For convalescent stroke patients with cognitive,psychological,physical movement and brain dysfunction,conventional MI training in a short course of treatment is difficult to obtain significant effects.MI training based on both visual and kinesthetic feedback BCI is suitable for clinical rehabilitation of hemiplegia patients in convalescent period of stroke,and can accelerate the recovery of cognitive,psychological and physical movement of patients in a short course of treatment.Its mechanisms include increased non-focus-side brain excitability and increased conduction of descending pathways.