Abstract
Study design
Feasibility and preliminary clinical efficacy analysis in a single-arm interventional study.
Objectives
We developed a brain–computer interface-triggered functional electrical stimulation therapy (BCI-FEST) system for clinical application and conducted an interventional study to (1) assess its feasibility and (2) understand its potential clinical efficacy for the rehabilitation of reaching and grasping in individuals with sub-acute spinal cord injury (SCI).
Setting
Spinal cord injury rehabilitation hospital—Toronto Rehabilitation Institute—Lyndhurst Centre.
Methods
Five participants with sub-acute SCI completed between 12 and 40 1-hour sessions using BCI-FEST, with up to 5 sessions a week. We assessed feasibility by measuring participants’ compliance with treatment, the occurrence of adverse events, BCI sensitivity, and BCI setup duration. Clinical efficacy was assessed using Functional Independence Measure (FIM) and Spinal Cord Independence Measure (SCIM), as primary outcomes. In addition, we used two upper-limb function tests as secondary outcomes.
Results
On average, participants completed 29.8 sessions with no adverse events. Only one of the 149 sessions was affected by technical challenges. The BCI sensitivity ranged between 69.5 and 80.2%, and the mean BCI setup duration was ~11 min. In the primary outcomes, three out of five participants showed changes greater than the minimal clinically important differences (MCIDs). Additionally, the mean change in secondary outcome measures met the threshold for detecting MCID as well; four out of five participants achieved MCID.
Conclusions
The new BCI-FEST intervention is safe, feasible, and promising for the rehabilitation of reaching and grasping after SCI.
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Acknowledgements
The authors would like to acknowledge the immense assistance of Alexandra Chen, Chandy Green, Cindy Gauthier, Debbie Hebert, Hikaru Yokoyama, Jaclyn Dawe, Parvin Eftekhar, and Sharmini Atputharaj in the conduct of this study.
Funding
This study was supported by a grant from the Ontario Neurotrauma Foundation (#2016-RHI-EEG-1020), in partnership with Praxis Spinal Cord Institute.
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Authors and Affiliations
Contributions
LIJ contributed to analyzing and interpreting the BCI results, creating the figures and tables, and writing the report. NK, VZ, HJR, MA, CM, and SKR contributed to data analysis and interpretation and the writing of the report. MRP and CMC contributed to interpreting the results and provided feedback on the report.
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Ethics declarations
Conflict of interest
MRP is a co-founder and a director of MyndTec, a company that manufactures transcutaneous functional electrical stimulators, and SKR is CEO and founder of Neural Outcomes Consulting, a company that manufactures the GRASSP and TRI-HFT. None of the remaining authors have conflicts of interest.
Ethics statement
This study was approved by the University Health Network Research Ethics Board.
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Jovanovic, L.I., Kapadia, N., Zivanovic, V. et al. Brain–computer interface-triggered functional electrical stimulation therapy for rehabilitation of reaching and grasping after spinal cord injury: a feasibility study. Spinal Cord Ser Cases 7, 24 (2021). https://doi.org/10.1038/s41394-020-00380-4
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DOI: https://doi.org/10.1038/s41394-020-00380-4
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