脑机接口联合多模态感知反馈训练对脑卒中后上肢功能恢复的探索性研究

Investigation of brain-computer interface with multimodal perception feedback training on functional recovery of upper limbs in chronic stroke patients

目的:探究基于运动想象的脑机接口技术联合多模态感知反馈训练对脑卒中后严重偏瘫患者上肢运动功能恢复的临床可行性及有效性。方法:本研究纳入在院康复脑卒中慢性期患者12例,在常规康复训练基础上,增加基于运动想象的脑机接口联合多模态感知反馈训练。在干预前后评估患者的上肢运动功能及日常生活活动能力,包括简化Fugl-Meyer量表上肢部分(FMA-UE)、腕关节主动活动度、手臂动作调查测试(action research arm test,ARAT)和Barthel指数(Barthel index,BI)。同时测量每位患者干预前后双侧M1区的运动诱发电位(motor evoked potentials,MEP),探讨脑机接口训练对脑重塑的影响。结果:所有患者均完成了治疗和评估,其中,FMA-UE及ARAT评分较干预前显著改善(P<0.05),FMA-UE从基线的(13.50±8.20)分提高到(15.92±9.28)分,ARAT评分从基线的(3.08±5.96)分提高到(4.75±7.52)分;所有患者在干预前均不能主动伸展腕关节,2例受试者有小范围的主动屈腕,而在干预后,4例患者出现了较为明显的患侧腕关节自主伸展,6例患者出现显著的腕关节主动屈曲;所有患者的BI评分均未显示出显著变化。在治疗过程中未观察到不良事件。结论:基于运动想象的脑机接口联合多模态感知反馈训练或能有效改善脑卒中严重偏瘫患者的上肢运动功能恢复。

Objective:To investigate the clinical feasibility and effectiveness of motor imagery based brain-computer interface with multimodal feedback training in chronic stroke patients with severe upper limb impairment.Method:Twelve patients with stroke were admitted from inpatient department.In addition to conventional training,motor imagery based brain-computer interface with multimodal feedback training was applied.Motor function of the upper limb and activities of daily living were evaluated before and after the intervention,including the Fugl-Meyer(upper limb),active wrist range of motion,action research arm test and Barthel index.Motor evoked potentials of bilateral M1 regions were measured before and after the intervention to explore the effect of brain-computer interface training on brain plasticity.Result:All participants completed all the assessments and treatments,among which,FMA-UE and ARAT scores showed significant improvements(P<0.05),FMA-UE improved from 13.50±8.20 to 15.92±9.28 while ARAT increased from 3.08±5.96 to 4.75±7.52.All the participants could not extend their paretic wrist and two participants could flex their wrist in a small range,while,after the intervention,4 patients could actively extend their paretic wrist and 6 patients had active wrist flexion.BI scores of all participants didn’t improve significantly.No adverse events occurred during the treatment.Conclusion:Motor imagery based brain-computer interface with multimodal perception feedback training may have some clinical feasibility and effectiveness for chronic stroke patients with severe upper limb motor impairment.