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Review
. 2021 Nov 18:12:772199.
doi: 10.3389/fneur.2021.772199. eCollection 2021.

Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces

Cornelius Angerhöfer  1 , Annalisa Colucci  1 , Mareike Vermehren  1 , Volker Hömberg  2 , Surjo R Soekadar  1
Affiliations
Review

Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces

Cornelius Angerhöfer et al. Front Neurol. .

Abstract

Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.

Keywords: brain-computer interface; long-term treatment; neurorehabilitation; neurotechnology; severe upper limb paresis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Feigin V, Roth G, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. . Global burden of diseases, injuries and risk factors study 2013 and stroke experts writing group. global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet Neurol. (2016) 15:913–24. 10.1016/S1474-4422(16)30073-4 - DOI - PubMed
    1. Eyding J, Bartig D, Weber R, Katsanos AH, Weimar C, Hacke W, et al. . Inpatient TIA and stroke care in adult patients in Germany-retrospective analysis of nationwide administrative data sets of 2011 to 2017. Neurol Res Pract. (2019) 1:1–8. 10.1186/s42466-019-0044-y - DOI - PMC - PubMed
    1. Icks A, Claessen H, Kvitkina T, Narres M, Weingärtner M, Schwab S, et al. . Incidence and relative risk of stroke in the diabetic and the non-diabetic population between 1998 and 2014: a community-based stroke register. PLoS ONE. (2017) 12:e0188306. 10.1371/journal.pone.0188306 - DOI - PMC - PubMed
    1. Rücker V, Wiedmann S, O'Flaherty M, Busch MA, Heuschmann PU. Decline in regional trends in mortality of stroke subtypes in Germany from 1998 to 2015. Stroke. (2018) 49:2577–83. 10.1161/STROKEAHA.118.023193 - DOI - PubMed
    1. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. . Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. (2001) 32:1279–84. 10.1161/01.STR.32.6.1279 - DOI - PubMed