Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study.

Introduction: Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. Methods: A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). Results: After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. Discussion: It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. Conclusion: The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.

Devices and Technology in Transcranial Magnetic Stimulation: A Systematic Review.

The technology for transcranial magnetic stimulation (TMS) has significantly changed over the years, with important improvements in the signal generators, the coils, the positioning systems, and the software for modeling, optimization, and therapy planning. In this systematic literature review (SLR), the evolution of each component of TMS technology is presented and analyzed to assess the limitations to overcome. This SLR was carried out following the PRISMA 2020 statement. Published articles of TMS were searched for in four databases (Web of Science, PubMed, Scopus, IEEE). Conference papers and other reviews were excluded. Records were filtered using terms about TMS technology with a semi-automatic software; articles that did not present new technology developments were excluded manually. After this screening, 101 records were included, with 19 articles proposing new stimulator designs (18.8%), 46 presenting or adapting coils (45.5%), 18 proposing systems for coil placement (17.8%), and 43 implementing algorithms for coil optimization (42.6%). The articles were blindly classified by the authors to reduce the risk of bias. However, our results could have been influenced by our research interests, which would affect conclusions for applications in psychiatric and neurological diseases. Our analysis indicates that more emphasis should be placed on optimizing the current technology with a special focus on the experimental validation of models. With this review, we expect to establish the base for future TMS technological developments.

Acoustic field modeling for physiotherapy ultrasound applicators by using approximated functions of measured non-uniform radiation distributions.

The strongest therapeutic effects in ultrasonic physiotherapy are mainly produced at the first centimeters, i.e. close to the applicator surface and, in general, only in the near-field zone. The acoustic field produced in practice by this type of transducers differs from the classical models because the vibration distribution on the real transducer surfaces is non-uniform. However, neither models using uniform distribution, nor those using typical non-uniform distribution patterns for the source accurately represent the radiation of this kind of transducers. Although this therapy is widely used and many efforts have been made in experimentally studying the patterns of ultrasound radiation produced during physiotherapy applications (IEC-61689, 1998), additional modeling researches still would be needed in order to achieve improved models giving field patterns closer to the measured ultrasonic results. In this paper, acoustic patterns produced from two source radiation functions are proposed and evaluated for field modeling of physiotherapy applicators. Both the functions are approximations to the pressure distribution measured close to the emitting surface and they are based on the modulation of the classical simply-supported function using either sinusoidal or Bessel-type distributions. The simply-supported function is accounted for the radiator-fixing condition and the modulation function simulates the complex vibration distribution of this kind of transducer. The modulator Bessel function is based on reports about Bessel-type vibration distributions found in piezoelectric disk resonators. The use of a selected sinusoidal segment represents another analytical option for obtaining an approximated behavior of the measured data in a real applicator. Both the field models are implemented using the finite element method (FEM) to obtain the numerical solution of wave equation at each point in the radiated space. The solution is reached by considering axisymmetric radiation in attenuation-free media. The results indicate the viability of applying an adequate model for acoustic field calculation by simulating the radiating distribution on the emitting surface as either sinusoidal or Bessel-modulated functions. Models using both the functions describe reasonably real behaviors, but those based on Bessel functions are better correlated with the measurements. The results for three commercial applicators indicate the possibility of representing, with adequate verisimilitude, the acoustic field radiated by physiotherapy ultrasound transducers using linear combinations of Bessel profiles describing the radiation source.