Stroke patients with severe upper limb movement deficits have limited treatment options and often remain severely handicapped at the chronic stage. Recent findings have suggested that poor motor recovery can be due to severe damage of the cortico-spinal tract (CST), the neural fibres connecting the movement regions of the brain to the spinal cord. Hence, to improve recovery of upper limb movements it will be crucial to re-establish and strengthen CST projections. Recent studies provided evidence that closed-loop brain computer interface-driven electrical stimulation of the paretic muscles can induce clinically important and lasting recovery of upper limb function, even in patients with chronic, severe motor affection. In this treatment approach, movement intentions of the patients are detected with electroencephalography and real-time analyses. This triggers an electrical stimulation of affected upper limb muscles. In this study, the investigators hypothesize that neuromuscular electrical stimulation (NMES) applied contingent to voluntary activation of primary motor cortex, as detected by a brain-computer interface (BCI), can help restore CST projections. This might improve recovery of patients with severe upper limb movement deficits. Treatment will be started within the first 8 weeks after stroke onset.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
31
From the recorded brain activity (EEG) subject specific patterns will be extracted with machine learning techniques from recordings where the subject executes movements tasks. Whenever a subject-specific pattern can be identified and detected, this is used for triggering neuromuscular electrical stimulation.
Neuromuscular electrical stimulation is triggered independently of the patient's movement intentions.
University of Austin
Austin, Texas, United States
Division of Neurorehabilitation, University Hospital of Geneva
Geneva, Canton of Geneva, Switzerland
Change in Upper Limb Fugl-Meyer Score, after treatment
Scale 0-66, higher scores indicate better outcome
Time frame: Difference between the week before the intervention and the week after intervention
Change in motor evoked potential amplitude of the paretic arm
Continuous measure, higher amplitude changes indicate better outcome
Time frame: Difference between the week before the intervention and the week after intervention
Change in fractional anisotropy (FA) of the cortico-spinal tract as determined from diffusion tensor imaging
FA can have values between 0 and 1, higher values indicate better outcome
Time frame: Difference between the week before the intervention and the week after intervention
Change in electroencephalography functional connectivity
Computed from high-density EEG recordings. Continuous measure. Higher values indicate better outcome.
Time frame: Difference between the week before the intervention and the week after intervention
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