Changes in functional connectivity correlate with behavioral gains in stroke patients after therapy using a brain-computer interface device

Brittany Mei Young; Zack Nigogosyan; Alexander Remsik; Léo M Walton; Jie Song; Veena A Nair; Scott W Grogan; Mitchell E Tyler; Dorothy Farrar Edwards; Kristin Caldera; Justin A Sattin; Justin C Williams; Vivek Prabhakaran

doi:10.3389/fneng.2014.00025

Changes in functional connectivity correlate with behavioral gains in stroke patients after therapy using a brain-computer interface device

Front Neuroeng. 2014 Jul 8:7:25. doi: 10.3389/fneng.2014.00025. eCollection 2014.

Authors

Affiliations

¹ Department of Radiology, University of Wisconsin - Madison Madison, WI, USA ; Medical Scientist Training Program, University of Wisconsin - Madison Madison, WI, USA ; Neuroscience Training Program, University of Wisconsin - Madison Madison, WI, USA.
² Department of Radiology, University of Wisconsin - Madison Madison, WI, USA.
³ Neuroscience Training Program, University of Wisconsin - Madison Madison, WI, USA ; Department of Biomedical Engineering, University of Wisconsin - Madison Madison, WI, USA.
⁴ Department of Radiology, University of Wisconsin - Madison Madison, WI, USA ; Department of Biomedical Engineering, University of Wisconsin - Madison Madison, WI, USA.
⁵ Department of Biomedical Engineering, University of Wisconsin - Madison Madison, WI, USA.
⁶ Departments of Kinesiology and Medicine, University of Wisconsin - Madison Madison, WI, USA.
⁷ Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison Madison, WI, USA.
⁸ Department of Neurology, University of Wisconsin - Madison Madison, WI, USA.
⁹ Neuroscience Training Program, University of Wisconsin - Madison Madison, WI, USA ; Department of Biomedical Engineering, University of Wisconsin - Madison Madison, WI, USA ; Department of Neurosurgery, University of Wisconsin - Madison Madison, WI, USA.
¹⁰ Department of Radiology, University of Wisconsin - Madison Madison, WI, USA ; Medical Scientist Training Program, University of Wisconsin - Madison Madison, WI, USA ; Neuroscience Training Program, University of Wisconsin - Madison Madison, WI, USA ; Department of Neurology, University of Wisconsin - Madison Madison, WI, USA ; Departments of Psychology and Psychiatry, University of Wisconsin - Madison Madison, WI, USA.

Abstract

Brain-computer interface (BCI) technology is being incorporated into new stroke rehabilitation devices, but little is known about brain changes associated with its use. We collected anatomical and functional MRI of nine stroke patients with persistent upper extremity motor impairment before, during, and after therapy using a BCI system. Subjects were asked to perform finger tapping of the impaired hand during fMRI. Action Research Arm Test (ARAT), 9-Hole Peg Test (9-HPT), and Stroke Impact Scale (SIS) domains of Hand Function (HF) and Activities of Daily Living (ADL) were also assessed. Group-level analyses examined changes in whole-brain task-based functional connectivity (FC) to seed regions in the motor network observed during and after BCI therapy. Whole-brain FC analyses seeded in each thalamus showed FC increases from baseline at mid-therapy and post-therapy (p < 0.05). Changes in FC between seeds at both the network and the connection levels were examined for correlations with changes in behavioral measures. Average motor network FC was increased post-therapy, and changes in average network FC correlated (p < 0.05) with changes in performance on ARAT (R (2) = 0.21), 9-HPT (R (2) = 0.41), SIS HF (R (2) = 0.27), and SIS ADL (R (2) = 0.40). Multiple individual connections within the motor network were found to correlate in change from baseline with changes in behavioral measures. Many of these connections involved the thalamus, with change in each of four behavioral measures significantly correlating with change from baseline FC of at least one thalamic connection. These preliminary results show changes in FC that occur with the administration of rehabilitative therapy using a BCI system. The correlations noted between changes in FC measures and changes in behavioral outcomes indicate that both adaptive and maladaptive changes in FC may develop with this therapy and also suggest a brain-behavior relationship that may be stimulated by the neuromodulatory component of BCI therapy.

Keywords: BCI therapy; UE motor recovery; brain-computer interface; fMRI; functional connectivity; stroke rehabilitation.

Abstract

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