Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial.
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2021
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Medicina
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Abstract
Background and Objectives: The motor sequelae after a stroke are frequently persistent and
cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the corticospinal
pathways are known to cause a reduction of cortical excitability in the lesioned area not only
for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action.
Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation
(rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS
have been shown to increase the excitability of the lesioned hemisphere. Mental representation
techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability
and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind,
randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain–Computer
Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper
limb motor recovery after subacute stroke (>3 months) compared to neuromodulation combined with
conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled
trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI),
dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and
changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention,
after each intervention and 15 days after the last session. Conclusions: This trial will show the additive
value of VR immersive motor imagery as an adjuvant therapy combined with a known effective
neuromodulation approach opening new perspectives for clinical rehabilitation protocols.
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Keywords
Stroke, Repetitive transcranial magnetic stimulation, BCI-VR training, Motor skills, Upper limb