Brain-computer interface training combined with transcranial direct current stimulation in patients with chronic severe hemiparesis: Proof of concept study
Yuko Kasashima-Shindo , Toshiyuki Fujiwara, Junichi Ushiba, Yayoi Matsushika, Daiki Kamatani , Misa Oto , Takashi Ono, Atsuko Nishimoto, Keiichiro Shindo, Michiyuki Kawakami, Tetsuya Tsuji, Meigen Liu
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
Objective: Brain–computer interface technology has been applied to stroke patients to improve their motor function. Event-related desynchronization during motor imagery, which is used as a brain–computer interface trigger, is sometimes difficult to detect in stroke patients. Anodal transcranial direct current stimulation (tDCS) is known to increase event-related desynchronization. This study investigated the adjunctive effect of anodal tDCS for brain–computer interface training in patients with severe hemiparesis.
Subjects: Eighteen patients with chronic stroke.
Design: A non-randomized controlled study.
Methods: Subjects were divided between a brain–computer interface group and a tDCS- brain–computer interface group and participated in a 10-day brain–computer interface training. Event-related desynchronization was detected in the affected hemisphere during motor imagery of the affected fingers. The tDCS-brain–computer interface group received anodal tDCS before brain–computer interface training. Event-related desynchronization was evaluated before and after the intervention. The Fugl-Meyer Assessment upper extremity motor score (FM-U) was assessed before, immediately after, and 3 months after, the intervention.
Results: Event-related desynchronization was significantly increased in the tDCS- brain–computer interface group. The FM-U was significantly increased in both groups. The FM-U improvement was maintained at 3 months in the tDCS-brain–computer interface group.
Conclusion: Anodal tDCS can be a conditioning tool for brain–computer interface training in patients with severe hemiparetic stroke.
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