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

Introduction: 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.
Methods: 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.
Results: 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 ² = 0%, p < 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 ² = 21%, p = 0.05), and the BCI-FES + CR vs. CR group (SMD = 0.61, 95% CI: 0.28-0.95, I ² = 0%, p = 0.0003). Moreover, BCI-FES training demonstrated effectiveness in both subacute (SMD = 0.56, 95% CI: 0.25-0.87, I ² = 0%, p = 0.0004) and chronic groups (SMD = 0.42, 95% CI: 0.05-0.78, I ² = 45%, p = 0.02). Subgroup analysis showed that both adjusting (SMD = 0.55, 95% CI: 0.24-0.87, I ² = 0%, p = 0.0006) and fixing (SMD = 0.43, 95% CI: 0.07-0.78, I ² = 46%, p = 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 ² = 13%, p = 0.006) and action observation (AO) (SMD = 0.73, 95% CI: 0.26-1.20, I ² = 0%, p = 0.002) as mental tasks significantly improved upper limb function in stroke patients.
Discussion: 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.
Systematic Review Registration: Identifier: CRD42023485744, https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42023485744.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2024 Ren, Li, Gao, Pan, Wang, Yang, Duan, Guo and Zhang.)