EEG-Triggered Functional Electrical Stimulation Therapy for Restoring Upper Limb Function in Chronic Stroke with Severe Hemiplegia

Cesar Marquez-Chin; Aaron Marquis; Milos R Popovic

doi:10.1155/2016/9146213

EEG-Triggered Functional Electrical Stimulation Therapy for Restoring Upper Limb Function in Chronic Stroke with Severe Hemiplegia

Case Rep Neurol Med. 2016:2016:9146213. doi: 10.1155/2016/9146213. Epub 2016 Nov 2.

Authors

Cesar Marquez-Chin¹, Aaron Marquis², Milos R Popovic³

Affiliations

¹ Rehabilitation Engineering Laboratory, The Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada M4G 3V9; Neural Engineering Laboratory, University Centre, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, ON, Canada M5G 2A2.
² Neural Engineering Laboratory, University Centre, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, ON, Canada M5G 2A2.
³ Rehabilitation Engineering Laboratory, The Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada M4G 3V9; Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Mining Building, 164 College Street, Room 407, Toronto, ON, Canada M5S 3E3.

Abstract

We report the therapeutic effects of integrating brain-computer interfacing technology and functional electrical stimulation therapy to restore upper limb reaching movements in a 64-year-old man with severe left hemiplegia following a hemorrhagic stroke he sustained six years prior to this study. He completed 40 90-minute sessions of functional electrical stimulation therapy using a custom-made neuroprosthesis that facilitated 5 different reaching movements. During each session, the participant attempted to reach with his paralyzed arm repeatedly. Stimulation for each of the movement phases (e.g., extending and retrieving the arm) was triggered when the power in the 18 Hz-28 Hz range (beta frequency range) of the participant's EEG activity, recorded with a single electrode, decreased below a predefined threshold. The function of the participant's arm showed a clinically significant improvement in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) subscore (6 points) as well as moderate improvement in Functional Independence Measure Self-Care subscore (7 points). The changes in arm's function suggest that the combination of BCI technology and functional electrical stimulation therapy may restore voluntary motor function in individuals with chronic hemiplegia which results in severe upper limb deficit (FMA-UE ≤ 15), a population that does not benefit from current best-practice rehabilitation interventions.