Cesar Marquez-Chin 1,2, Shehroz Khan 1, and Milos R. Popovic 1,3
1 Toronto Rehabilitation Institute – University Health Network
2 Department of Occupational Sciences and Occupational Therapy, University of Toronto
3 Institute of Biomaterials and Biomedical Engineering, University of Toronto
Current best practices of rehabilitation are ineffective in restoring any meaningful upper extremity function in individuals with chronic severe hemiplegia resulting from stroke [1,2]. There is evolving evidence that Functional Electrical Stimulation Therapy (FEST) is successful in restoring upper limb (UL) motor function after stroke, including in individuals with chronic severe hemiplegia (defined here as a Fugl-Meyer Upper Extremity Score , FMA-UE, ≤ 15) [1,4-6]. However, the changes are not as significant as those seen in individuals with acute stroke and with lower levels of impairment . We recently developed and tested the feasibility and efficacy of a new version of FEST in two individuals with chronic severe hemiplegia. This technology uses neurological indicators of a person’s intention to move to trigger the electrical stimulation: patients are asked to attempt a functional movement, and the electrical stimulation is triggered when their electroencephalographic activity indicates the intention to move. This is achieved by using brain-computer interfacing (BCI) technology. The new therapy is not only feasible but produced clinically significant and meaningful changes in the UL function of both the individuals treated. In the previous six years since sustaining their stroke, every other intervention, including state-of-the-art FEST, had failed to produce any meaningful change in upper extremity function in both these individuals. To the best of our knowledge, no other study has explored the use of a BCI-triggered FEST (BCI+FEST) to restore joint functional reaching and grasping movements in individuals with chronic severe hemiplegia. Improvements to our BCI+FEST will rely heavily on artificial intelligence methods to develop predictive models to enhance its reliability and transparency of interaction. Our long-term goal is to develop a rehabilitation intervention to restore functional reaching and grasping in individuals with severe motor impairments who currently experience minimal improvements with conventional rehabilitation options.
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- Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975 Jan 1;7(1):13–31.
- Popovic MR, Thrasher TA, Zivanovic V, Takaki J, Hajek V. Neuroprosthesis for retraining reaching and grasping functions in severe hemiplegic patients. Neuromodulation. 2005 Jan;8(1):58–72.
- Hebert DA, Bowen JM, Ho C, Antunes I, O’Reilly DJ, Bayley M. Examining a new functional electrical stimulation therapy with people with severe upper extremity hemiparesis and chronic stroke: A feasibility study. British Journal of Occupational Therapy. 2017 Nov;80(11):651–9.
- Marquez-Chin C, Marquis A, Popovic MR. EEG-Triggered Functional Electrical Stimulation Therapy for Restoring Upper Limb Function in Chronic Stroke with Severe Hemiplegia. Case Reports in Neurological Medicine [Internet]. 2016;2016(1):1–11. Available from: https://www-hindawi-com.myaccess.library.utoronto.ca/journals/crinm/2016/9146213/