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Recommendations for combining brain-computer interface, motor imagery and virtual reality in upper limb stroke rehabilitation: a qualitative person-centered study

2024-12Master thesis Embargoed access
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dc.contributor.advisorPereira, Carla Mendes
dc.contributor.advisorAlmeida, Ana Isabel
dc.contributor.advisorVourvopoulos, Athanasios
dc.contributor.authorOliveira, Inês Catarina Rodrigues
dc.date.accessioned2025-02-10T11:59:25Z
dc.date.embargo2026-01-01
dc.date.issued2024-12
dc.description.abstractBackground: 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.pt_PT
dc.identifier.tid203799992pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/54335
dc.language.isoengpt_PT
dc.subjectNeurological Rehabilitationpt_PT
dc.subjectCerebrovascular Disorderspt_PT
dc.subjectUpper Extremitypt_PT
dc.subjectBrain-computer interfacespt_PT
dc.subjectHealth Planning Guidelinespt_PT
dc.subjectQualitative Researchpt_PT
dc.subjectUser-Centered Designpt_PT
dc.titleRecommendations for combining brain-computer interface, motor imagery and virtual reality in upper limb stroke rehabilitation: a qualitative person-centered studypt_PT
dc.typemaster thesis
dspace.entity.typePublication
rcaap.rightsembargoedAccesspt_PT
rcaap.typemasterThesispt_PT
thesis.degree.grantorInstituto Politécnico de Setúbal
thesis.degree.nameMestrado de Prática Avançada de Fisioterapia em Neurologiapt_PT

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