Action observation training and brain-computer interface controlled functional electrical stimulation enhance upper extremity performance and cortical activation in patients with stroke: a randomized controlled trial

PURPOSE: Brain-computer interface (BCI)-functional electronic stimulation (FES) systems are increasingly being explored as potential neuro-rehabilitation tools. Here, we investigate the effect of action observation training (AOT) plus electroencephalogram (EEG)-based BCI-controlled FES system on motor recovery of upper extremity and cortical activation in patients with stroke. METHOD: There were a total of 26 patients: an AOT plus BCI-FES group (n = 13) and a control group (n = 13). The control group performed FES treatment and the conventional physical therapy, while the AOT plus BCI-FES group performed AOT plus BCI-FES and the conventional physical therapy. Upper extremity performance was measured using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL) and Modified Barthel Index (MBI). Cortical activation was measured using electro-encephalographic recordings from alpha and beta power, concentration, and activation. RESULTS: After intervention, there were significant differences between two groups in FMA-UE, WMFT, MAL and MBI and the results of EEG including alpha power, beta power, concentration and activation. CONCLUSIONS: This study demonstrated that AOT plus BCI-FES can enhance motor function of upper extremity and cortical activation in patients with stroke. This training method may be feasible and suitable for individuals with stroke.