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Study Protocol

Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial

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Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
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Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
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Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
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Faculdade de Ciências Exatas e da Engenharia, Madeira Interactive Technologies Institute, NOVA LINCS, Universidade da Madeira, 9020-105 Funchal, Portugal
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Neural and Cognitive Engineering Group (gNeC), Centre for Automation and Robotics (CAR), Spanish National Research Council (CSIC-UPM), 28500 Arganda del Rey, Spain
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Brain Damage Unit, Beata María Ana Hospital, 28007 Madrid, Spain
*
Author to whom correspondence should be addressed.
Academic Editor: Luca Nicola Ferraro
Medicina 2021, 57(8), 736; https://doi.org/10.3390/medicina57080736
Received: 14 June 2021 / Accepted: 19 July 2021 / Published: 21 July 2021
(This article belongs to the Special Issue Neurorehabilitation of Neurodegenerative Diseases and Brain Damage)
Background and Objectives: The motor sequelae after a stroke are frequently persistent and cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the cortico-spinal pathways are known to cause a reduction of cortical excitability in the lesioned area not only for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action. Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation (rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS have been shown to increase the excitability of the lesioned hemisphere. Mental representation techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind, randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain–Computer Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper limb motor recovery after subacute stroke (>3 months) compared to neuromodulation combined with conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI), dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention, after each intervention and 15 days after the last session. Conclusions: This trial will show the additive value of VR immersive motor imagery as an adjuvant therapy combined with a known effective neuromodulation approach opening new perspectives for clinical rehabilitation protocols. View Full-Text
Keywords: stroke; repetitive transcranial magnetic stimulation; BCI-VR training; motor skills; upper limb stroke; repetitive transcranial magnetic stimulation; BCI-VR training; motor skills; upper limb
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MDPI and ACS Style

Sánchez-Cuesta, F.J.; Arroyo-Ferrer, A.; González-Zamorano, Y.; Vourvopoulos, A.; Badia, S.B.i.; Figuereido, P.; Serrano, J.I.; Romero, J.P. Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial. Medicina 2021, 57, 736. https://doi.org/10.3390/medicina57080736

AMA Style

Sánchez-Cuesta FJ, Arroyo-Ferrer A, González-Zamorano Y, Vourvopoulos A, Badia SBi, Figuereido P, Serrano JI, Romero JP. Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial. Medicina. 2021; 57(8):736. https://doi.org/10.3390/medicina57080736

Chicago/Turabian Style

Sánchez-Cuesta, Francisco José, Aida Arroyo-Ferrer, Yeray González-Zamorano, Athanasios Vourvopoulos, Sergi Bermúdez i Badia, Patricia Figuereido, José Ignacio Serrano, and Juan Pablo Romero. 2021. "Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial" Medicina 57, no. 8: 736. https://doi.org/10.3390/medicina57080736

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