Rehabilitation of Chronic Stroke Using Neurofeedback, Functional Electrical Stimulation and Cerebrospinal Direct Current Stimulation

This work presents the application of a rehabilitation protocol using a novel Non-Invasive Brain Stimulation (NIBS) technique, called cerebrospinal Direct Current Stimulation (csDCS), together with the use of a Brain-Computer Interface (BCI) based on Motor Imagery (MI) with Neurofeedback (NFB), and applying Functional Electrical Stimulation (FES) plus the use of a pedal exerciser. This protocol uses the concept of Alternating Treatment Design (ATD), in which a chronic post-stroke subject is submitted to these techniques to recover his left hand and leg movements. The rehabilitation progress was verified through metrics, such as Fugl Meyer Assessment (FMA), Functional Independence Measure (FIM), Ashworth Scale, Muscle Strength Grading (MSG), and surface Electromyography (sEMG). Results from these metrics include a 41% gain in hand function recovery, a 5% gain in performance in motor and cognitive/social domains, and a 50% improvement in both wrist extensor muscle strength and finger extensor muscle strength. In addition, there was a 17% gain of Maximum Voluntary Contraction (MVC) for the tibialis anterior muscle of the patient's left leg. On the other hand, there was a worsening in some values of EMG, probably due to the participant having received application of botulinum toxin in his hand.