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Restoration of upper-limb function after chronic severe hemiplegia

A case report on the feasibility of a brain-computer interface controlled functional electrical stimulation therapy

Jovanovic, Lazar I., BSc1,2; Kapadia, Naaz, MSc1,3; Lo, Lorna, MSc1; Zivanovic, Vera, MD1; Popovic, Milos R., PhD, PEng1,2,3; Marquez-Chin, Cesar, PhD1

American Journal of Physical Medicine & Rehabilitation: February 13, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001163
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Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function following neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper-limb function in a 57-year old male with severe left hemiplegia resulting from a stroke six years prior to enrollment in the study. The intervention consisted of two blocks of 40 one-hour BCI-FEST sessions (total of 80 sessions) for the left upper limb, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (i) Functional Independence Measure, (ii) Action Research Arm Test (ARAT), (iii) Toronto Rehabilitation Institute – Hand Function Test (TRI-HFT), and (iv) Fugl-Meyer Assessment Upper Extremity test (FMA-UE). Upon completion of 80 therapy sessions, 14-point, 17-point and 18-point changes were recorded on ARAT, FMA-UE and TRI-HFT, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable.

1 Toronto Rehabilitation Institute - University Health Network

2 Institute of Biomaterials and Biomedical Engineering, University of Toronto

3 Rehabilitation Sciences Institute, University of Toronto

Correspondence: Lazar I. Jovanovic, 550 University Avenue, #10-203, Toronto, Ontario, M5G 2A2, Canada. Phone: +1 (416) 597-3422 Ext. 7869. Email: lazar.jovanovic@mail.utoronto.ca

Author Disclosures: Milos R. Popovic is the chief technology officer of MyndTec, a Canadian company that designs, produces, and commercializes functional electrical stimulation therapy systems for upper limb rehabilitation. Naaz Desai (Kapadia) is a paid Consultant at MyndTec, Inc. All other authors have no competing interests.

Funding for this project was partially provided by the Ontario Neurotrauma Foundation (Award# 2016-RHI-EEG-1020) and Dean Connor and Maris Uffelmann Donation.

There are no financial benefits to the authors.

The results from this case study were presented in the form of poster presentations at the 13th Toronto Rehabilitation Institute Research Day (January 2018) and the Institute of Biomaterials and Biomedical Engineering Annual Research Conference 2018 (May 2018).

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