Restoration of post-stroke upper limb paralysis with BMI neurorehabilitation

      Recent studies indicate greater potential for neural plasticity, and newer approaches aiming at functional restoration of the upper extremity (UE) have been attempted. Among them, constraint-induced movement therapy has been proved effective, but its application is limited to mild to moderate hemiparesis. To counter this, we devised a therapeutic approach to facilitate daily use of hemiparetic UE by combining EMG triggered electrical stimulation with a wrist splint, called the hybrid assistive neuromuscular dynamic stimulation (HANDS). With HANDS, we demonstrated improved motor functions, spasticity, functional scores and neurophysiological parameters in patients with chronic and subacute stroke. However, to be its candidates, EMG must be recorded from finger extensors, and it cannot be applied to patients with complete paralysis. For them, we developed Brain-machine interface (BMI) neurorehabilitation that provides real time feedback based on the analysis of volitionally decreased amplitudes of sensory motor rhythm (SMR) during motor imagery involving extension of the affected fingers. A pilot study demonstrated appearance of voluntary EMG in the affected finger extensors, improved finger function, greater suppression of SMR during motor imagery, increased cortical excitability as assessed with TMS, and increased daily use of the paralyzed hand. We also demonstrated that kinesthetic feedback is more effective than visual feedback, and indicated effectiveness of BMI neurorehabilitation by comparing true with pseudo BMI. After elucidating the mechanism of improvement with electrophysiological and brain imaging techniques, we are now performing a physician-led RCT to obtain its pharmaceutical approval for wider clinical use.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect