Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface

Introduction Brain computer interface is an emerging technology to treat the sequelae of stroke. The purpose of this study was to explore the motor imagery related desynchronization of sensorimotor rhythms of stroke patients and to assess the efficacy of an upper limb neurorehabilitation therapy based on functional electrical stimulation controlled by a brain computer interface. Methods Eight severe chronic stroke patients were recruited. The study consisted of two stages: screening and therapy. During screening, the ability of patients to desynchronize the contralateral oscillatory sensorimotor rhythms by motor imagery of the most affected hand was assessed. In the second stage, a therapeutic intervention was performed. It involved 20 sessions where an electrical stimulator was activated when the patient's cerebral activity related to motor imagery was detected. The upper limb was assessed, before and after the intervention, by the Fugl–Meyer score (primary outcome). Spasticity, motor activity, range of movement and quality of life were also evaluated (secondary outcomes). Results Desynchronization was identified in all screened patients. Significant post-treatment improvement (p