Brain-computer interfaces for inducing brain plasticity and motor learning: implications for brain-injury rehabilitation

摘要

The goal of this investigation was to explore the efficacy of implementing a rehabilitation robot controlled by a noninvasive brain-computer interface (BCI) to influence brain plasticity and facilitate motor learning. The motivation of this project stemmed from the need to address the population of stroke survivors who have few or no options for therapy. 
\nA stroke occurs every 40 seconds in the United States and it is the leading cause of long-term disability [1-3]. In a country where the elderly population is growing at an astounding rate, one in six persons above the age of 55 is at risk of having a stroke. Internationally, the rates of strokes and stroke-induced disabilities are comparable to those of the United States [1, 4-6]. Approximately half of all stroke survivors suffer from immediate unilateral paralysis or weakness, 30-60% of which never regain function [1, 6-9]. Many individuals who survive stroke will be forced to seek institutional care or long-term assistance. 
\n\tClinicians have typically implemented stroke rehabilitative treatment using active training techniques such as constraint induced movement therapy (CIMT) and robotic therapy [10-12]. Such techniques restore motor activity by forcing the movement of weakened limbs. That active engagement of the weakened limb movement stimulates neural pathways and activates the motor cortex, thus inducing brain plasticity and motor learning. Several studies have demonstrated that active training does in fact have an effect on the way the brain restores itself and leads to faster rehabilitation [10, 13-15]. In addition, studies involving mental practice, another form of rehabilitation, have shown that mental imagery directly stimulates the brain, but is not effective unless implemented as a supplemental to active training [16, 17]. Only stroke survivors retaining residual motor ability are able to undergo active rehabilitative training; the current selection of therapies has overlooked the significant population of stroke survivors suffering from severe control loss or complete paralysis [6, 10].
\nA BCI is a system or device that detects minute changes in brain signals to facilitate communication or control. In this investigation, the BCI was implemented through an electroencephalograph (EEG) device. EEG devices detect electrical brain signals transmitted through the scalp that corresponded with imagined motor activity. Within the BCI, a linear transformation algorithm converted EEG spectral features into control commands for an upper-limb rehabilitative robot, thus implementing a closed-looped feedback-control training system. The concept of the BCI-robot system implemented in this investigation may provide an alternative to current therapies by demonstrating the results of bypassing motor activity using brain signals to facilitate robotic therapy. 
\nIn this study, 24 able-bodied volunteers were divided into two study groups; one group trained to use sensorimotor rhythms (SMRs) (produced by imagining motor activity) to control the movement of a robot and the other group performed the 'guided-imagery' task of watching the robot move without control. This investigation looked for contrasts between the two groups that showed that the training involved with controlling the BCI-robot system had an effect on brain plasticity and motor learning.
\nTo analyze brain plasticity and motor learning, EEG data corresponding to imagined arm movement and motor learning were acquired before, during, and after training. Features extracted from the EEG data consisted of frequencies in the 5-35Hz range, which produced amplitude fluctuations that were measurably significant during reaching. Motor learning data consisted of arm displacement measures (error) produced during an motor adaptation task performed daily by all subjects. 
\n\tThe results of the brain plasticity analysis showed persistent reductions in beta activity for subjects in the BCI group. The an