AUTHOR=Ren Chunlin , Li Xinmin , Gao Qian , Pan Mengyang , Wang Jing , Yang Fangjie , Duan Zhenfei , Guo Pengxue , Zhang Yasu 

TITLE=The effect of brain-computer interface controlled functional electrical stimulation training on rehabilitation of upper limb after stroke: a systematic review and meta-analysis

JOURNAL=Frontiers in Human Neuroscience

VOLUME=18

YEAR=2024

URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2024.1438095

DOI=10.3389/fnhum.2024.1438095

ISSN=1662-5161

ABSTRACT=<sec id="sec1001"><title>Introduction</title><p>Several clinical studies have demonstrated that brain-computer interfaces (BCIs) controlled functional electrical stimulation (FES) facilitate neurological recovery in patients with stroke. This review aims to evaluate the effectiveness of BCI-FES training on upper limb functional recovery in stroke patients.</p></sec><sec id="sec2001"><title>Methods</title><p>PubMed, Embase, Cochrane Library, Science Direct and Web of Science were systematically searched from inception to October 2023. Randomized controlled trials (RCTs) employing BCI-FES training were included. The methodological quality of the RCTs was assessed using the PEDro scale. Meta-analysis was conducted using RevMan 5.4.1 and STATA 18.</p></sec><sec id="sec3001"><title>Results</title><p>The meta-analysis comprised 290 patients from 10 RCTs. Results showed a moderate effect size in upper limb function recovery through BCI-FES training (SMD = 0.50, 95% CI: 0.26–0.73, I<sup>2</sup> = 0%, <italic>p</italic> &lt; 0.0001). Subgroup analysis revealed that BCI-FES training significantly enhanced upper limb motor function in BCI-FES vs. FES group (SMD = 0.37, 95% CI: 0.00–0.74, I<sup>2</sup> = 21%, <italic>p</italic> = 0.05), and the BCI-FES + CR vs. CR group (SMD = 0.61, 95% CI: 0.28–0.95, I<sup>2</sup> = 0%, <italic>p</italic> = 0.0003). Moreover, BCI-FES training demonstrated effectiveness in both subacute (SMD = 0.56, 95% CI: 0.25–0.87, I<sup>2</sup> = 0%, <italic>p</italic> = 0.0004) and chronic groups (SMD = 0.42, 95% CI: 0.05–0.78, I<sup>2</sup> = 45%, <italic>p</italic> = 0.02). Subgroup analysis showed that both adjusting (SMD = 0.55, 95% CI: 0.24–0.87, I<sup>2</sup> = 0%, <italic>p</italic> = 0.0006) and fixing (SMD = 0.43, 95% CI: 0.07–0.78, I<sup>2</sup> = 46%, <italic>p</italic> = 0.02). BCI thresholds before training significantly improved motor function in stroke patients. Both motor imagery (MI) (SMD = 0.41 95% CI: 0.12–0.71, I<sup>2</sup> = 13%, <italic>p</italic> = 0.006) and action observation (AO) (SMD = 0.73, 95% CI: 0.26–1.20, I<sup>2</sup> = 0%, <italic>p</italic> = 0.002) as mental tasks significantly improved upper limb function in stroke patients.</p></sec><sec id="sec4001"><title>Discussion</title><p>BCI-FES has significant immediate effects on upper limb function in subacute and chronic stroke patients, but evidence for its long-term impact remains limited. Using AO as the mental task may be a more effective BCI-FES training strategy.</p></sec><sec><title>Systematic review registration</title><p>Identifier: CRD42023485744, <uri xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023485744" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023485744</uri>.</p></sec>