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Central and Peripheral Neural Interfaces for Control of Upper Limb Actuators for Motor Rehabilitation After Stroke: Technical and Clinical Considerations

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Abstract

Stroke is the leading cause of sensorimotor disability worldwide. Recently, neurorehabilitation therapies based on neural interfaces have paved the way toward new effective rehabilitation strategies exploiting neural plasticity mechanisms and have produced promising results even in extremely compromised patients. In this chapter, we review and discuss several aspects of the design and use of neural interfaces coupled with upper limb actuators (robotics and functional electrical stimulation (FES)) for motor rehabilitation after stroke. We first describe the burden of stroke and the limitations of currently used rehabilitation strategies. Secondly, we analyze different neural interfacing methods to reinforce the brain-to-muscle link leveraging previous neuroscientific findings on motor learning and functional neuroplasticity. We review current clinical trials using this technology and analyze its effect on the sensorimotor function of stroke patients, reported as clinical and neurophysiological parameters. Thirdly, we provide several guidelines for the optimal design of these systems to boost motor recovery. We conclude with some recommendations and thoughts for future development of this technology in stroke rehabilitation.

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Abbreviations

ARAT:

Action Research Arm Test

ASH:

Ashworth scale

BCI:

Brain–computer interface

BMI:

Brain–machine interface

CCI:

Co-contraction index

CIMT:

Constraint-induced movement therapy

CMC:

Cortico-muscular coherence

CMI:

Cortico-muscular interface

CNS:

Central nervous system

CSP:

Common spatial pattern

CST:

Corticospinal tract

CVA:

Cerebrovascular accident

DoF:

Degree of freedom

ECoG:

Electrocorticography

EEG:

Electroencephalography

EMG:

Electromyography

ERD:

Event-related desynchronization

ERS:

Event-related synchronization

FES:

Functional electrical stimulation

FMA:

Fugl-Meyer assessment

fMRI:

Functional Magnetic Resonance Imaging

fNIRS:

Functional near-infrared spectroscopy

hBMI:

Hybrid brain–machine interface

LFP:

Local field potential

MAS:

Modified Ashworth scale

MEG:

Magnetoencephalography

M1:

Primary motor cortex

MI:

Myoelectric interface

ML:

Machine learning

MRCP:

Movement-related slow cortical potentials

NI:

Neural interface

NIBS:

Noninvasive brain stimulation

NMES:

Neuromuscular Magnetic Electrical Stimulation

OSF:

Optimal spatial filter

PNS:

Peripheral nervous system

RMS:

Root mean square

SCI:

Spinal cord injury

SEP:

Sensory evoked potentials

SIAS:

Stroke Impairment Assessment Set

sLDA:

Sparse linear discriminant analysis

SMR:

Sensorimotor rhythm

SNR:

Signal-to-noise ratio

STDP:

Spike time-dependent plasticity

SVM:

Support vector machine

tDCS:

Transcranial direct current stimulation

WMFT:

Wolf Motor Function Test

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Authors and Affiliations

  1. Neuroprosthetics Group, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany

    Nerea Irastorza-Landa, Andrea Sarasola-Sanz, Carlos Bibián, Andreas M. Ray, Ainhoa Insausti-Delgado, Florian Helmhold, Wala J. Mahmoud, Iñaki Ortego-Isasa, Eduardo López-Larraz & Ander Ramos-Murguialday

  2. International Max Planck Research, School for Cognitive and Systems Neuroscience, Tübingen, Germany

    Nerea Irastorza-Landa, Carlos Bibián, Ainhoa Insausti-Delgado, Florian Helmhold & Wala J. Mahmoud

  3. IKERBASQUE, Basque Foundation for Science, Bilbao, Spain

    Nerea Irastorza-Landa & Ainhoa Insausti-Delgado

  4. Neuroengineering Department, TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia -- San Sebastián, Spain

    Nerea Irastorza-Landa, Andrea Sarasola-Sanz, Iñaki Ortego-Isasa & Ander Ramos-Murguialday

  5. Bitbrain, Zaragoza, Spain

    Eduardo López-Larraz

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  1. Nerea Irastorza-Landa
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    Nitish V. Thakor

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    Alcimar Soares

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Irastorza-Landa, N. et al. (2022). Central and Peripheral Neural Interfaces for Control of Upper Limb Actuators for Motor Rehabilitation After Stroke: Technical and Clinical Considerations. In: Thakor, N.V. (eds) Handbook of Neuroengineering. Springer, Singapore. https://doi.org/10.1007/978-981-15-2848-4_120-1

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