Hand
Research Papers
Active Physical Practice Followed by Mental Practice Using BCI-Driven Hand Exoskeleton: A Pilot Trial for Clinical Effectiveness and Usability
Appropriately combining mental practice (MP) and physical practice (PP) in a poststroke rehabilitation is critical for ensuring a substantially positive rehabilitation outcome. Here, we present a rehabilitation protocol incorporating a separate active PP stage followed by MP stage, using a hand exoskeleton and brain-computer interface (BCI). The PP stage was mediated by a force sensor feedback-based assist-as-needed control strategy, whereas the MP stage provided BCI-based multimodal neurofeedback combining anthropomorphic visual feedback and proprioceptive feedback of the impaired hand extension attempt. A six week long clinical trial was conducted on four hemiparetic stroke patients (screened out of 16) with a left-hand disability. The primary outcome, motor functional recovery, was measured in terms of changes in grip-strength (GS) and action research arm test (ARAT) scores; whereas the secondary outcome, usability of the system was measured in terms of changes in mood, fatigue, and motivation on a visual-analog-scale. A positive rehabilitative outcome was found as the group mean changes from the baseline in the GS and ARAT were +6.38 kg and +5.66 accordingly. The VAS scale measurements also showed betterment in mood ( 1.38), increased motivation (+2.10) and reduced fatigue (0.98) as compared to the baseline. Thus, the proposed neurorehabilitation protocol is found to be promising both in terms of clinical effectiveness and usability.
View Full Paper →Higher-order Brain Areas Associated with Real-time Functional MRI Neurofeedback Training of the Somato-motor Cortex
Neurofeedback (NFB) allows subjects to learn self-regulation of neuronal brain activation based on information about the ongoing activation. The implementation of real-time functional magnetic resonance imaging (rt-fMRI) for NFB training now facilitates the investigation into underlying processes. Our study involved 16 control and 16 training right-handed subjects, the latter performing an extensive rt-fMRI NFB training using motor imagery. A previous analysis focused on the targeted primary somato-motor cortex (SMC). The present study extends the analysis to the supplementary motor area (SMA), the next higher brain area within the hierarchy of the motor system. We also examined transfer-related functional connectivity using a whole-volume psycho-physiological interaction (PPI) analysis to reveal brain areas associated with learning. The ROI analysis of the pre- and post-training fMRI data for motor imagery without NFB (transfer) resulted in a significant training-specific increase in the SMA. It could also be shown that the contralateral SMA exhibited a larger increase than the ipsilateral SMA in the training and the transfer runs, and that the right-hand training elicited a larger increase in the transfer runs than the left-hand training. The PPI analysis revealed a training-specific increase in transfer-related functional connectivity between the left SMA and frontal areas as well as the anterior midcingulate cortex (aMCC) for right- and left-hand trainings. Moreover, the transfer success was related with training-specific increase in functional connectivity between the left SMA and the target area SMC. Our study demonstrates that NFB training increases functional connectivity with non-targeted brain areas. These are associated with the training strategy (i.e., SMA) as well as with learning the NFB skill (i.e., aMCC and frontal areas). This detailed description of both the system to be trained and the areas involved in learning can provide valuable information for further optimization of NFB trainings.
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