Restoration of upper-limb function after chronic severe hemiplegia: A case report on the feasibility of a brain-computer interface controlled functional electrical stimulation therapy.

Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function following neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper-limb function in a 57-year old male with severe left hemiplegia resulting from a stroke six years prior to enrollment in the study. The intervention consisted of two blocks of 40 one-hour BCI-FEST sessions (total of 80 sessions) for the left upper limb, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (i) Functional Independence Measure, (ii) Action Research Arm Test (ARAT), (iii) Toronto Rehabilitation Institute - Hand Function Test (TRI-HFT), and (iv) Fugl-Meyer Assessment Upper Extremity test (FMA-UE). Upon completion of 80 therapy sessions, 14-point, 17-point and 18-point changes were recorded on ARAT, FMA-UE and TRI-HFT, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable.