The Effectiveness of Constraint Induced Movement Therapy Associated with a Brain-computer Interface on the Functionality of the Severely Affected Upper Limb After Stroke

Research Objectives: (1) To analyze the effectiveness of Constraint-Induced Movement Therapy (CIMT) combined with a Brain-Computer Interface (BCI) on the functionality of the severely affected upper limb after stroke; (2) to determine the better therapeutic approach, CIMT or CIMT+BCI, for this population and its retention; and (3) to verify participants' perception regarding changes after the interventions.

Design: Controlled, randomized, and blinded clinical trial.

Setting: Referral rehabilitation center.

Participants: A random sample of individuals with stroke, in the chronic phase of recovery (≥ 6 months), aged between 18 and 80 years, and with an Upper Extremity Fugl-Meyer scale score ≤53 points (out of 66 points) and a deficit in active finger extension of the most affected hand, was screened for the study.

Interventions: (1) CIMT; (2) CIMT + BCI; and (3) Control.

Main Outcome Measures: Participants were evaluated by a blinded evaluator at three time points: T0) baseline; T1) immediately after interventions; T2) one month after the end of interventions (retention). The primary outcome was the Upper Extremity Fugl-Meyer Scale (UE-FM), and secondary outcomes were the Modified Ashworth Scale (MAS), Graded Wolf Motor Function Test (GWMFT) - time and functional ability, Canadian Occupational Performance Measure (COPM) - Performance and Satisfaction, Grade-4/5 Motor Activity Log-Brazil (MAL 4/5) - frequency and quality of affected upper limb use.

Results: The sample size was 53 participants, with a mean age of 56 (±11) years and 62 (±76) months post-stroke. Statistically significant differences were detected between the CIMT and Control group in COPM (Satisfaction, p=0.05) and between the CIMT+BCI and Control group in MAL 4/5 (frequency of use, p=0.04; quality of use, p=0.03) immediately after the interventions. One month after the interventions, differences were detected between the CIMT+BCI and Control group in MAL 4/5 (quality of use, p=0.02). The primary outcome, UE-FM, did not show significant differences between groups post-intervention.

Conclusions: CIMT+BCI could yield better results, especially regarding activities carried out in participants’ real lives, measured with COPM and MAL 4/5. However, no significant differences were observed in the primary outcome, UE-FM. This suggests that while CIMT+BCI may enhance certain functional outcomes, more extensive studies with larger sample sizes are needed to understand its full impact on upper limb functionality post-stroke.

Author(s) Disclosures: The authors declare that they have no conflict of interest.