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Stroke is the leading cause of serious and long-term disability worldwide.Some studies have shown that motor imagery (MI) based BCI has a positive effectin poststroke rehabilitation. It could help patients promote the reorganizationprocesses in the damaged brain regions. However, offline motor imagery andconventional online motor imagery with feedback (such as rewarding sounds andmovements of an avatar) could not reflect the true intention of the patients.In this study, both virtual limbs and functional electrical stimulation (FES)were used as feedback to provide patients a closed-loop sensorimotorintegration for motor rehabilitation. The FES system would activate if the userwas imagining hand movement of instructed side. Ten stroke patients (7 male,aged 22-70 years, mean 49.5+-15.1) were involved in this study. All of themparticipated in BCI-FES rehabilitation training for 4 weeks.The average motorimagery accuracies of the ten patients in the last week were 71.3%, which hasimproved 3% than that in the first week. Five patients' Fugl-Meyer Assessment(FMA) scores have been raised. Patient 6, who has have suffered from strokeover two years, achieved the greatest improvement after rehabilitation training(pre FMA: 20, post FMA: 35). In the aspect of brain patterns, the activepatterns of the five patients gradually became centralized and shifted tosensorimotor areas (channel C3 and C4) and premotor area (channel FC3 andFC4).In this study, motor imagery based BCI and FES system were combined toprovided stoke patients with a closed-loop sensorimotor integration for motorrehabilitation. Result showed evidences that the BCI-FES system is effective inrestoring upper extremities motor function in stroke. In future work, morecases are needed to demonstrate its superiority over conventional therapy andexplore the potential role of MI in poststroke rehabilitation.

BCI-Based Strategies on Stroke Rehabilitation with Avatar and FES Feedback