Stroke
Conditions
Keywords
Brain-computer interface, functional electrical stimulation, Tele-rehabilitation, stroke rehabilitation
Brief summary
The study aims to identify whether stroke survivors can intentionally modulate their brain signals for controlling an FES device to produce arm movements for home based rehabilitation. The study also assess the participants acceptability of this new home-based rehabilitation.
Detailed description
Movements of different parts of the body, including the arm, start when the brain produces specific electrical signals. Sometimes after a stroke, even though the person intends to move the arm, the arm will not move or will only move partly. The brain continues to produce electrical signals after stroke, but when the signals are weak the arm does not move. Brain-computer interface (BCI), is a method of utilising the brain signals to produce useful outputs via computers. One type of BCI is BCI Functional Electrical Stimulus (BCI-FES) which is a device that can detect these brain signals produced during the intention to move the weak arm after a stroke. It then uses these signals to trigger an electrical stimulator. The electrical stimulator then stimulates the muscles in the weak arm to produce the desired arm movement. Recent studies show that rehabilitation using this device has given better results when compared with conventional rehabilitation approaches. However, the BCI-FES devices currently available are bulky and participants need to come to the hospital or laboratory to receive the treatment. Our project aims to develop a BCI-FES device, called Tele BCI-FES that can be used at stroke participant's home. The investigators are using techniques like machine learning to make the Tele BCI-FES quick and simple to set up, easy to use and effective. This study aims to investigate if the proposed Tele BCI-FES device is a feasible and acceptable intervention for post-stroke rehabilitation.
Interventions
DEVICEThe BCI-FES Intervention
To evaluate whether the participant can effectively control FES using the developed remote BCI system. Thus, participants will receive a three-week BCI-FES intervention at their home, including three sessions of intervention per week. Each session will last around 60 minutes, including 10 minutes of preparation, 40 minutes of intervention and 10 minutes interview on the user's experience with the device and any experienced side effects, if any.
Sponsors
Sheffield Teaching Hospitals NHS Foundation Trust
Medical Research Council
University of Sheffield
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DEVICE_FEASIBILITY
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1\) Age 18 and above. (2) Experienced an ischaemic or haemorrhagic stroke more than 6 months ago. (3) Arm weakness interfering with activities of daily living. (4) Fugl-Meyer score of upper limb\<45. (5) Caregiver is willing to assist with trial by helping to deliver intervention. (6) Cognitive and language abilities to understand and participate in the study protocol. (7) Can maintain sitting with or without support for 1 hour continuously. (8) Able to give consent and understand instructions.
Exclusion criteria
1. Cognitive impairment that would interfere with their ability to comply with the experimental protocol or provide informed consent; 2. Dermatological, rheumatologic or orthopaedic illnesses of the affected arm interfering with movement of the elbow; 3. Pre-existing severe systemic disorders like cardiovascular disease; active cancer or renal disease; end stage pulmonary or cardiovascular disease; psychiatric illness including severe alcohol or drug abuse 4. Inability to perform the baseline assessments; 5. Severe tactile hypersensitivity; 6. Participation in other, upper limb rehabilitation studies 7. Within 12 weeks of receiving Botulinum toxin injections; 8. History of epilepsy 9. Pace maker or any other implanted devices 10. Pregnancy 11. Severe dystonia/spasm
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate the usability and acceptability of the proposed system based on the number of participants completing each TeleBCI-FES intervention session | through study completion, an average of 5 weeks | Number of participants completing each TeleBCI-FES intervention session (Success: 7 participants completed 8 or more of 12 TeleBCI-FES sessions) |
| Recruitment rate | Pre-intervention | To measure the acceptability of the proposed rehabilitation |
| Evaluate the feasibility of the proposed system through the ability of participants to control the Tele BCI-FES | within 10 minutes after experimental session | To evaluate whether the participants can effectively control FES using the developed remote BCI system (Success: the BCI accuracy of more than 70% in at least 7 out of 9 sessions). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Modified Ashworth Scale | Pre-intervention and up to 5 weeks | This looks at elbow and wrist flexors on predefined scale. The scale ranges from 0 to 4 (worst). |
| Medical Research Council grading | Pre-intervention and up to 5 weeks | This looks at assessing muscle strength from Grade 5 (normal) to Grade 0 (no visible contraction) and takes around 10 minutes to complete. |
| Leeds Arm Spasticity Scale-reference | Baseline and up to 5 weeks | It is a measure of passive arm function, suitable for participants with spasticity and little or no active movement of the upper extremity. The score ranges from 0 (No difficulty) to 4 (Inability to perform the activity). |
| Pittsburgh Participation in Rehabilitation scale | within 10 minutes after experimental session | It is a clinician-rated measure on a 6-point Likert-type scale that quantifies individuals' participation in their therapy sessions, ranging from 1 (None: participant refused the entire session) to 6 (Excellent: participant participated in all sessions) |
| European Quality of List 5D-5L (EQ-5D-5L): | Pre-intervention and .up to 5 weeks | It is a self-assessed, health related, quality of life questionnaire. The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each level is assigned a rating based on the severity of the problems in that area (no problems walking, minor problems, moderate problems, severe problems, or inability to walk). The tool also includes an overall health scale, on which the participant chooses a number between 1 and 100 (best) to represent their health status. |
| Numerical rating Scale (NRS) | Pre-intervention and up to 5 weeks | It requires the participant to rate their pain on a defined scale from 0 (no pain) to 10 (the worst pain) |
| Fugl-Meyer Assessment | Pre-intervention and up to 5 weeks | It is the most frequently used outcome scales to measure post stroke motor recovery of the upper extremity on a scale of 0-60 (best). |
| Action Research Arm Test | Pre-intervention and up to 5 weeks | It is a 19 item observational measure used to assess upper extremity performance on a scale of 0 - 57 (best). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Interviews | within 10 minutes after experimental session | A qualitative assessment of the effectiveness and acceptability of treatment for participants. |
Countries
United Kingdom
Outcome results
None listed