Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study

• Main Authors: Ang, K.K (Author), Cheng, H.-J (Author), Chew, E. (Author), Chong, J.S.X (Author), Chuang, K.-H (Author), Guan, C. (Author), Hu, M. (Author), Huang, W. (Author), Ji, F. (Author), Jiang, X. (Author), Lu, Z. (Author), Phua, K.S (Author), Zhou, J.H (Author)
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2021
• Subjects: amplitude of low-frequency fluctuation; brain-computer interface-assisted motor imagery; functional connectivity; functional magnetic resonance imaging; regional homogeneity; stroke; transcranial direct current stimulation
• Online Access: View Fulltext in Publisher

 Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness. © Copyright © 2021 Hu, Cheng, Ji, Chong, Lu, Huang, Ang, Phua, Chuang, Jiang, Chew, Guan and Zhou.