Active Physical Practice Followed by Mental Practice Using BCI-Driven Hand Exoskeleton: A Pilot Trial for Clinical Effectiveness and Usability

Appropriately combining mental practice (MP) and physical practice (PP) in a post-stroke rehabilitation is critical for ensuring a substantially positive rehabilitation outcome. Here we present a rehabilitation protocol incorporating a separate active PP stage followed by MP stage, using a hand exoskeleton and brain-computer interface (BCI). The PP stage was mediated by a force sensor feedback based assist-as-needed control strategy, whereas the MP stage provided BCI based multimodal neurofeedback combining anthropomorphic visual feedback and proprioceptive feedback of the impaired hand extension attempt. A 6 week long clinical trial was conducted on 4 hemiparetic stroke patients (screened out of 16) with left hand disability. The primary outcome, motor functional recovery, was measured in terms of changes in Grip-Strength (GS) and Action Research Arm Test (ARAT) scores; whereas the secondary outcome, usability of the system, was measured in terms of changes in mood, fatigue and motivation on a visual-analog-scale (VAS). A positive rehabilitative outcome was found as the group mean changes from the baseline in the GS and ARAT were +6.38 kg and +5.66 accordingly. The VAS scale measurements also showed betterment in mood (-1.38), increased motivation (+2.10) and reduced fatigue (-0.98) as compared to the baseline. Thus the proposed neurorehabilitation protocol is found to be promising both in terms of clinical effectiveness and usability.