Publicação
Bobath oncept and brain-computer interface: combined approach to enhance neuroplasticity in chronic stroke
| Resumo: | One of the major goals of stroke rehabilitation is the recovery of upper limb function. Physical therapy, based on the Bobath Concept (PT), is the most common intervention in stroke patients, and shows good results, despite the lack of well-controlled trials. In addition, neurofeedback techniques using electroencephalography (EEG)-based brain computer interfaces (BCI) to guide motor imagery, have recently emerged as valuable rehabilitation tools, however, little research has been carried out in stroke patients. Studies showed that the main strategy adopted during motor imagery (MI) training involves familiar tasks, and only seemed beneficial in chronic stroke patients, specially associated with other forms of intervention, such as physical therapy. Nonetheless, it is not clear if and how MI training with neurofeedback BCI systems, promotes not only clinical but also neurophysiologic changes in stroke patients. Moreover, we found that despite the incremental use of EEG-fMRI studies, there is lack of exploration of the relationship between changes in brain symmetry index (BSI) and blood oxygen level-dependent (BOLD) responses in chronic stroke patients. The second part of this thesis aims to: analyze the relationship changes in BSI and BOLD responses during multitasks (motor execution or MI for both the affected/unaffected hand). We also assess the neural mechanisms underlying the improvement of upper limb function after PT and test whether the association of a MI with neurofeedback EEG-based BCI to a PT program can further enhance the efficacy of the latter in neuroplasticity and in the recovery of upper limb function in chronic stroke patients. We found that time post stroke was negatively correlated with contralesional cerebellum activity and changes in BOLD activation patterns were related to BSI variation and different from the affected compared to unaffected hand movement and during execution compared with MI. It seems that 4-weeks of a PT program promotes recovery of upper limb function and neuroplasticity even in chronic stroke patients, in particularly in ipsilesional precentral and post central area and contralesional cerebellum. MI training guided through real neurofeedback from BCI can help to improve upper limb function and brain symmetry compared to sham neurofeedback, in chronic stroke patients, however, conclusions must be carefully taken into consideration, given the extremely limited number of patients. In conclusion, PT can change upper limb function and neuroplasticity in chronic stroke patients, MI guided through neurofeedback from BCI can be an adjunctive treatment since improves not only upper limb function but also brain symmetry. Large trials of PT associated to MI training with BCI in this population are justified. |
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| Autores principais: | Ribeiro, Raquel da Glória Teixeira de Carvalho |
| Assunto: | Ciências Médicas::Ciências da Saúde |
| Ano: | 2018 |
| País: | Portugal |
| Tipo de documento: | tese de doutoramento |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade do Minho |
| Idioma: | inglês |
| Origem: | RepositóriUM - Universidade do Minho |
| Resumo: | One of the major goals of stroke rehabilitation is the recovery of upper limb function. Physical therapy, based on the Bobath Concept (PT), is the most common intervention in stroke patients, and shows good results, despite the lack of well-controlled trials. In addition, neurofeedback techniques using electroencephalography (EEG)-based brain computer interfaces (BCI) to guide motor imagery, have recently emerged as valuable rehabilitation tools, however, little research has been carried out in stroke patients. Studies showed that the main strategy adopted during motor imagery (MI) training involves familiar tasks, and only seemed beneficial in chronic stroke patients, specially associated with other forms of intervention, such as physical therapy. Nonetheless, it is not clear if and how MI training with neurofeedback BCI systems, promotes not only clinical but also neurophysiologic changes in stroke patients. Moreover, we found that despite the incremental use of EEG-fMRI studies, there is lack of exploration of the relationship between changes in brain symmetry index (BSI) and blood oxygen level-dependent (BOLD) responses in chronic stroke patients. The second part of this thesis aims to: analyze the relationship changes in BSI and BOLD responses during multitasks (motor execution or MI for both the affected/unaffected hand). We also assess the neural mechanisms underlying the improvement of upper limb function after PT and test whether the association of a MI with neurofeedback EEG-based BCI to a PT program can further enhance the efficacy of the latter in neuroplasticity and in the recovery of upper limb function in chronic stroke patients. We found that time post stroke was negatively correlated with contralesional cerebellum activity and changes in BOLD activation patterns were related to BSI variation and different from the affected compared to unaffected hand movement and during execution compared with MI. It seems that 4-weeks of a PT program promotes recovery of upper limb function and neuroplasticity even in chronic stroke patients, in particularly in ipsilesional precentral and post central area and contralesional cerebellum. MI training guided through real neurofeedback from BCI can help to improve upper limb function and brain symmetry compared to sham neurofeedback, in chronic stroke patients, however, conclusions must be carefully taken into consideration, given the extremely limited number of patients. In conclusion, PT can change upper limb function and neuroplasticity in chronic stroke patients, MI guided through neurofeedback from BCI can be an adjunctive treatment since improves not only upper limb function but also brain symmetry. Large trials of PT associated to MI training with BCI in this population are justified. |
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