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Feasibility of a New Application of Noninvasive Brain Computer Interface (BCI): A Case Study of Training for Recovery of Volitional Motor Control After Stroke

Daly, Janis J. MSPT, PhD; Cheng, Roger BME; Rogers, Jean PT; Litinas, Krisanne MS, BME; Hrovat, Kenneth MS, BME; Dohring, Mark PhD

Journal of Neurologic Physical Therapy: December 2009 - Volume 33 - Issue 4 - pp 203-211
doi: 10.1097/NPT.0b013e3181c1fc0b
Case Studies

Background/Purpose: A large proportion of individuals with stroke have persistent deficits for which current interventions have not restored normal motor behavior. Noninvasive brain computer interfaces (BCIs) have potential advantages for restoration of function. There are also potential advantages for combining BCI with functional electrical stimulation (FES). We tested the feasibility of combined BCI + FES for motor learning after stroke.

Case Description: The participant was a 43-year-old woman who was 10 months post-stroke. She was unable to produce isolated movement of any of the digits of her involved hand. With effort she exhibited simultaneous mass hyperextension of metacarpal phalangeal joints of all four fingers and thumb with simultaneous flexion of proximal interphalangeal and distal interphalangeal joints of all fingers.

Intervention: Brain signals from the lesioned hemisphere were used to trigger FES for movement practice. The BCI + FES intervention consisted of trials of either attempted finger movement and relax conditions or imagined finger movement and relax conditions. The training was performed three times per week for three weeks (nine sessions total).

Outcome: The participant exhibited highly accurate control of brain signal in the first session for attempted movement (97%), imagined movement (83%), and some difficulties with attempted relaxation (65%). By session 6, control of relaxation (deactivation of brain signal) improved to >80%. After nine sessions (three per week) of BCI + FES intervention, the participant demonstrated recovery of volitional isolated index finger extension.

Discussion: BCI + FES training for motor learning after stroke was feasible. A highly accurate brain signal control was achieved, and this signal could be reliably used to trigger the FES device for isolated index finger extension. With training, volitional control of isolated finger extension was attained in a small number of sessions. The source of motor recovery could be attributable to BCI, FES, combined BCI + FES, or whole arm or hand motor task practice.

Cognitive and Motor Learning Research Program, (J.J.D., R.C., J.R., K.L., K.H., M.D.), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio; and Professor, Department of Neurology, (J.J.D.), Case Western Reserve University School of Medicine, Cleveland Ohio.

Supported by the Department of Veterans Affairs, Office of Rehabilitation Research and Development (grants B3388R and B508S) and NIH (grant R01 NS-063275).

None of the authors of this manuscript have any competing financial conflicts of interest.

Address correspondence to: Janis J. Daly, E-mail:

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© 2009 Neurology Section, APTA