Brain-Machine Interface in Chronic Stroke: Randomized Trial Long-Term Follow-up.
Ander Ramos-Murguialday, Marco R Curado, Doris Broetz and 8 others
PMID 30722727WHAT IT FOUND
Patients with severe chronic stroke arm paresis who received contingent brain-machine interface training plus physiotherapy had higher combined hand and arm motor scores six months later than before.
Sham training plus physiotherapy did not significantly change scores. BMI was not tested without physiotherapy.
Key findings
01The group that received contingent brain-machine interface training plus physiotherapy had combined hand and arm motor scores of 11.16 before treatment and 13.44 at follow-up, a significant increase.
02The group that received sham brain-machine interface training plus physiotherapy changed from 13.29 to 14.75 on the same score, a non-significant change.
03The long-term gain was seen in arm scores but not in hand scores.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The analysed groups were small: 16 in the experimental group and 12 in the sham group. The follow-up report was delayed because of personnel, organizational and time constraints. Patients could receive other rehabilitation after the trial, and most continued the physiotherapy they had before the intervention. Home exercise was not checked day by day, and self-reported frequency may not capture actual training. The authors state that the motor improvement has not reached a level with significant clinical impact. Several secondary outcomes did not support the main motor result, including hand scores, muscle activity group comparisons, and brain-imaging changes. The sham orthosis produced correct-looking feedback by chance for about 20% of training time. This may have induced some limited neuroplastic changes. The design does not allow firm conclusions about how much behavioral physiotherapy contributed, because both groups received it.
Declared interests
The authors reported no potential conflicts of interest. The supplied publication types list NIH and non-U.S. government research support.
The easy way to misread this
Do not conclude that brain-machine interface training alone restores hand function in chronic stroke. The participants also received physiotherapy, the long-term gain was mainly in arm scores rather than hand scores, and the sample was small with several secondary outcomes null.