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Upper Limb Recovery in Cervical Spinal Cord Injury After a Brain-Computer Interface Controlled Functional Electrical Stimulation Intervention

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Abstract

Purpose

Upper limb motor recovery is highly relevant for individuals with tetraplegia after spinal cord injury (SCI). Experimental interventions based on Brain–Computer Interfaces and Functional Electrical Stimulation (BCI-FES) could provide clinical benefits. However, their effects have been scarcely reported. For this reason, a pilot study was performed for assessing the feasibility of a BCI-FES intervention in tetraplegia.

Methods

Six chronic cervical SCI patients completed 12 intervention sessions with a BCI–FES controlled with the motor intention of paralyzed upper extremities. Differences in the Action Research Arm Test (ARAT), Spinal Cord Independence Measure (SCIM-III), Capabilities of Upper Extremity Questionnaire (CUE-Q), Upper Extremity Motor Score (UEMS) and Life Satisfaction Questionnaire were assessed to measure recovery. Patients’ performance and experience with the system were also evaluated.

Results

Half of the patients had a significant ARAT function improvement of more than 5.7 points. Five out of six patients had more independence, measured by a median increase of 9 points of the SCIM-III. Two patients had noticeable gains in life satisfaction and in the UEMS. There were no noticeable changes in the CUE-Q. Patients had an average success rate of 80% while attempting to control the system and rated their experience with the BCI-FES in the range of excellent with a workload perceived as moderately high.

Conclusion

Relevant clinical improvements associated with the BCI-FES intervention were observed in most of the patients. Moreover, the BCI-FES was successfully operated by patients and offered an adequate usability and workload. Although preliminary in nature, the observed effects of the BCI-FES intervention confirm its feasibility and potential for the neurorehabilitation of chronic cervical SCI patients, that currently have limited treatment options.

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Data Availability

All data analyzed during this study are included in this published article.

Material availability

Not applicable.

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Acknowledgements

The authors would like to thank Karla Daniela Uribe Rebollo and Emmanuel Simental Aldaba for their aid during therapy sessions. The authors also acknowledge National Council of Science and Technology of Mexico (CONACYT) for grant 268958 and grant PN2015-873.

Funding

This work was supported by the National Council of Science and Technology of Mexico (CONACYT) under Grant 268958 and Grant PN2015-873.

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Authors and Affiliations

  1. Division of Research in Clinical Neuroscience, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, 14389, Mexico City, Mexico

    Jessica Cantillo-Negrete & Ruben I. Carino-Escobar

  2. Postgraduate Program in Medical Sciences, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, 14389, Mexico City, Mexico

    Ismael Leyva-Martinez

  3. Division of Neurological Rehabilitation, Instituto Nacional de Rehabilitación “Luis Gullermo Ibarra Ibarra”, 14389, Mexico City, Mexico

    Aida Barrera-Ortiz & Marlene A. Rodriguez-Barragan

  4. Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, 64894, Monterrey, Mexico

    Omar Mendoza-Montoya & Javier M. Antelis

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  1. Jessica Cantillo-Negrete
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JC-N, RIC-E, OM-M and IL-M. The first draft of the manuscript was written by JC-N and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jessica Cantillo-Negrete or Javier M. Antelis.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics and Research Committees of the National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra” (No. 08/19).”

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Cantillo-Negrete, J., Carino-Escobar, R.I., Leyva-Martinez, I. et al. Upper Limb Recovery in Cervical Spinal Cord Injury After a Brain-Computer Interface Controlled Functional Electrical Stimulation Intervention. J. Med. Biol. Eng. 43, 522–531 (2023). https://doi.org/10.1007/s40846-023-00824-w

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