Upper Limb Recovery in Cervical Spinal Cord Injury After a Brain-Computer Interface Controlled Functional Electrical Stimulation Intervention

PurposeUpper limb motor recovery is highly relevant for individuals with tetraplegia after spinal cord injury (SCI). Experimental interventions based on Brain-Computer Interfaces and Functional Electrical Stimulation (BCI-FES) could provide clinical benefits. However, their effects have been scarcely reported. For this reason, a pilot study was performed for assessing the feasibility of a BCI-FES intervention in tetraplegia.MethodsSix chronic cervical SCI patients completed 12 intervention sessions with a BCI-FES controlled with the motor intention of paralyzed upper extremities. Differences in the Action Research Arm Test (ARAT), Spinal Cord Independence Measure (SCIM-III), Capabilities of Upper Extremity Questionnaire (CUE-Q), Upper Extremity Motor Score (UEMS) and Life Satisfaction Questionnaire were assessed to measure recovery. Patients' performance and experience with the system were also evaluated.ResultsHalf of the patients had a significant ARAT function improvement of more than 5.7 points. Five out of six patients had more independence, measured by a median increase of 9 points of the SCIM-III. Two patients had noticeable gains in life satisfaction and in the UEMS. There were no noticeable changes in the CUE-Q. Patients had an average success rate of 80% while attempting to control the system and rated their experience with the BCI-FES in the range of excellent with a workload perceived as moderately high.ConclusionRelevant clinical improvements associated with the BCI-FES intervention were observed in most of the patients. Moreover, the BCI-FES was successfully operated by patients and offered an adequate usability and workload. Although preliminary in nature, the observed effects of the BCI-FES intervention confirm its feasibility and potential for the neurorehabilitation of chronic cervical SCI patients, that currently have limited treatment options.