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Publication
Recommendations for combining brain-computer interface, motor imagery and virtual reality in upper limb stroke rehabilitation: a qualitative person-centered study
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Abstract(s)
Background: The high incidence and prevalence of upper limb impairment poststroke highlights the need for the development of rehabilitation in this field. BrainComputer Interfaces (BCIs) can directly train the central nervous system providing
promising technology in this area and the use of associated motor imagery (MI) and
virtual reality (VR) can provide valuable rehabilitative opportunities. However, the
diversity in interventions designs demonstrates the lack of guiding recommendations
integrating neurorehabilitation principles for BCI.
Objective: This study aims to develop recommendations for BCI interventions using
task specificity and ecological validity through simulated VR tasks for upper limb
stroke survivors, by gathering tacit knowledge from neurorehabilitation experts,
patients’ experiences, and engineers’ expertise to ensure a comprehensive approach.
Methods: a multi-perspective qualitative study was conducted through collaborative
design workshops involving stroke survivors (N=17), rehabilitation experts (N=13)
and biomedical engineers (N=3), totaling 33 participants. This innovative approach
aimed to actively engage stakeholders in developing multifaceted solutions for
complex health interventions.
Results: Six themes emerged from the thematic analysis: i) Importance of patient
centred approach; ii) Clinical evaluation and patient selection; iii) Recommendations
for task design; iv) Guidelines for structuring BCI intervention; v) Key factors
influencing motivation; and vi) Technology features. From these themes, the
following recommendations (R) are established: R1 - BCI-MI-VR interventions must
be conducted through a Patient Centered Approach, based on individualized
preferences, needs and goals of the user, by an interdisciplinary team; R2 - Selection
criteria must include upper limb impairment, cognitive and communication
assessment and clinical traits like motor imagery capacity, neglect and depression
must be assessed once it might influence intervention outcomes; R3 - Tasks to
perform should preferably be based on daily living activities including unilateral and
bilateral tasks and a variety of tasks must be available for selection to ensure
significance for the user and adequation to clinical traits; R4 - Intervention must be
structured by different progressing levels starting with simple, gross movements and
adding complexity through movement features, cognitive demand and motor imagery
difficulty; R5 - Optimal levels of motivation must be sustained through task
variability, gamification elements and task demand adequacy; R6 - Multisensorial
potential of BCI-MI-VR must be effectively harnessed through the adequate
adjustment of visual, haptic and proprioceptive feedback modalities to the patient. Conclusions: These results contribute to establishing clear guidelines on patient
selection, task design, intervention structuring, motivation factors and tailoring of
sensory feedback. This framework presents a foundation for optimal implementation
of BCI-MI-VR based interventions, optimizing cortical activity during the
intervention, patients’ engagement and clinical outcomes. Future research should
explore the application of these guidelines for validation and investigate BCI’s efficacy
according to different combinations of patients’ profiles, task characteristics and
technology features.
Description
Keywords
Neurological Rehabilitation Cerebrovascular Disorders Upper Extremity Brain-computer interfaces Health Planning Guidelines Qualitative Research User-Centered Design