EEG Based BCI for Upper Limb Rehabilitation in Stroke

Study Overview
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Brief Summary
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Biomedical and Engineering approaches form a key element to neurological rehabilitation of upper limbs. Brain Computer Interface (BCI) using Motor execution and Motor Imagery are known to aid motor recovery in stroke. The purpose of this study is to demonstrate that Noninvasive Sensorimotor Rhythm (SMR) based EEG based BCI using motor execution and Motor Imagery tasks can aid in rehabilitation of upper limb movements in chronic stroke. The project aims to explore an SMR-based BCI system that can exploit the sensorimotor rhythm voluntary modulation to play a virtual game as neurofeedback using motor executory tasks and imagined hand movements by stroke patients, who suffer from upper limb disability.

Detailed Description
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Brain Computer Interface (BCI) using Motor execution and Motor Imagery are known to aid motor recovery in stroke. The purpose of this study is to demonstrate that Noninvasive Sensorimotor Rhythm (SMR) based EEG based BCI using motor execution and Motor Imagery tasks can aid in rehabilitation of upper limb movements in chronic stroke. The project aims to explore an SMR-based BCI system that can exploit the sensorimotor rhythm voluntary modulation to play a virtual game as neurofeedback using motor executory tasks and imagined hand movements by stroke patients, who suffer from upper limb disability. Studies have shown that movement and motor imagery (MI) (i.e., the mental rehearsal of a movement without any activation of the muscles) induce similar EEG patterns over the motor cortex. Movement execution, preparation and even observation are usually accompanied by a decrease in µ- and β-rhythm in the cortical area representing the involved body segment. Such a reduction is called event-related desynchronization (ERD).The increase in µ-rhythm, i.e. event-related synchronization (ERS), is observed in the regions of the brain representing body segments, which are not involved in the task.This study is a pilot study to examine the feasibility of a SMR based EEG BCI using motor task and motor imagery and involve a gaming feedback for same. The first two days will be used for calibrating the BMI using commands in computer screen followed by further two days for testing the BMI and feedback control during gaming in computer to move the ball in the computer screen.

Official Title
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EEG Based Brain Computer Interface in Chronic Stroke Survivors for Upper Limb Rehabilitation- A Pilot Study Using Motor Execution and Motor Imagery

Conditions
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Stroke Sequelae, Brain Ischemia

Intervention / Treatment
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* Other: EEG -BCI based Feedback for rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • age: 21-75 years Subacute or chronic stroke; interval of at least 3 months and interval of at least 6 months from stroke to time of enrollment, respectively. no cerebellar signs or bilateral motor deficit Cognitive ability to consent, assimilate, and participate actively in the treatment protocol (Mini Mental State Examination score > 24 points, out of a total 30 indicating normal cognitive ability); Modified Rankin scale scores 1-3 (Mild-Moderate functional disability post-stroke); Modified Ashworth Scale of Spasticity score <= 3 (ranges from 0-4 with 4 reflecting maximum spasticity) No epilepsy /usage of antiepileptic drug ◦ Subjects with Stroke will be included if they have: unilateral impaired upper limb Able to initiate hand movements like opening and closing fist and no joint contracture or severe spasticity in the affected upper limbs. Sufficient sitting balance to participate in experimental activities. No condition (e.g. severe arthritis, central pain) that would interfere with the administration of motor function tests. English-language comprehension and cognitive ability sufficient to give informed consent (MMSE >=24) and to cooperate with the intervention. Exclusion Criteria: • Orthopedic conditions of either upper or lower extremity that would affect performance on the study untreated depression that may affect motivation to participate in the study vascular cognitive impairment interfering with comprehending the tasks Individuals with stroke who have been diagnosed with cognitive or severe visual deficits, hemineglect, uncontrolled angina, or pregnancy no psychiatric or neurological condition other than stroke ◦ Stroke will be excluded if they have: Pregnancy (Self -reported) Dementia (MMSE score less than 24) Recurrence of stroke (Occurrence of new focal deficits reported by patient or detected by PI on examination during visits)

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: Pilot study in patients with fulfilling the eligibility criteria
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EEG BCI closed loop feedback for rehabilitation of upper limb<br>This study is a pilot study to examine the feasibility of a SMR based EEG BCI using motor task and motor imagery and involve a gaming feedback for same. The first two days will be used for calibrating the BMI using commands in computer screen followed by further two days for testing the BMI and feedback control during gaming in computer to move the ball in the computer screen. | Other: EEG -BCI based Feedback for rehabilitation<br>* Subjects will undergo EEG based BCI as feedback for rehabilitation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl-Meyer Assessment score (Upper limb)(Min0-Max66;Total 66) | Change in Hand strength | 4 days | 
| Decoding motor intent of hand movements using Scalp Electroencephalography(EEG) | Electroencephalographic spectral power changes during Motor execution and Motor Imagery of hand movements in stroke subjects | 4 days |