Impact of motor imagery‐based brain‐computer interface combined with virtual reality on enhancing attention, executive function, and lower‐limb function in stroke: A pilot study

Abstract Background Brain–computer interface combined with virtual reality (BCI‐VR) can reduce the difficulty of motor imagery execution and improve training performance. Few studies have focused on the effects of BCI‐VR on attention, executive function, and lower‐limb function in stroke. Objective To evaluate feasibility and preliminary efficacy of BCI‐VR pedaling training on the attention, executive function, and lower‐extremity function in people after stroke. It will also provide data support for future research, especially sample size calculations. Design A single group before‐after trial design was used. All participants had a stable level of function over a 2‐week period to ensure that their functional recovery was all attributable to BCI‐VR training. Setting The study was conducted in a specialized rehabilitation hospital. Participants Twelve participants with stroke, a certain level of motor imagery ability, capable of walking 10 meters continuously. Interventions All participants received a 4‐week BCI‐VR pedaling training program, 5 days per week, 30 minutes each session. Outcome Measures Primary outcomes are feasibility and safety. Secondary outcomes were lower‐extremity mobility, attention, and executive functions. Results Twelve patients were recruited from inpatient rehabilitation and nine completed the study (six males/three females; 56.6 ± 11.6 years). Recruitment and retention rates were 34% and 75%, respectively. Excellent adherence rate (97.7%) was obtained. No adverse events or equipment issues were reported. Following the intervention, significant improvements were found in the lower‐extremity strength, balance, walking stability, attention, and general cognitive function ( p < .05). A significant correlation was found between improved Berg balance scale change values and symbol digit modalities test change values ( p < .05, r = 0.677). Conclusions BCI‐VR pedaling training provides a depth of feasibility and safety data, methodological detail, and preliminary results. This could provide a useful basis for future studies of BCI‐VR pedaling training for stroke rehabilitation. ClinicalTrials .gov registration number: ChiCTR2300071522 ( http://www.chictr.org.cn ).