Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis.
Zhongfei Bai, Kenneth N K Fong, Jack Jiaqi Zhang and 2 others
PMID 32334608WHAT IT FOUND
Long-term upper-limb function after stroke did not show a clear BCI benefit over control at follow-up.
BCI training did show immediate improvement compared with control interventions.
Key findings
01In 12 controlled studies, 174 patients in BCI groups and 139 in control groups showed greater immediate upper-limb function improvement for BCI training than control interventions, with a standardized mean difference of 0.42 and a 95% confidence interval from 0.18 to 0.66.
02In five long-term studies with follow-up from 6 weeks to 6 to 12 months, BCI training did not show a significant differential effect compared with control interventions, with a standardized mean difference of 0.12 and a 95% confidence interval from -0.28 to 0.52.
03In the device subgroup, only BCI combined with FES had a significant immediate effect compared with control interventions, with a standardized mean difference of 1.04 and a 95% confidence interval from 0.47 to 1.62; BCI with robots or visual feedback did not show a significant effect.
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 long-term analysis used few studies and different follow-up times, so it cannot show whether benefits persist. The immediate pooled result mixed studies with different BCI mental tasks and feedback devices. The FES advantage came from subgroup meta-analysis, not a direct device comparison. Many studies combined BCI with conventional rehabilitation and a feedback device, so the contribution of BCI alone cannot be separated. Some controlled studies had fair methodological quality, and single-group studies were not pooled. Adverse events were reported by only some studies, so safety conclusions are limited.
Declared interests
The authors declare no competing interests. Government research funds supported the work, and the funders had no role in study design, data collection and analysis, publication decision, or manuscript preparation.
The easy way to misread this
Do not conclude that BCI-based rehabilitation produces lasting upper-limb recovery. The long-term follow-up analysis did not show a significant differential effect, and the significant benefit was reported immediately after training.