The Application of Brain-Computer Interface in Upper Limb Dysfunction After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Yang Peng, Jing Wang, Zicai Liu, Lida Zhong, Xin Wen, Pu Wang, Xiaoqian Gong, Huiyu Liu, Yang Peng, Jing Wang, Zicai Liu, Lida Zhong, Xin Wen, Pu Wang, Xiaoqian Gong, Huiyu Liu

Abstract

Objective: This study aimed to examine the effectiveness and safety of the Brain-computer interface (BCI) in treatment of upper limb dysfunction after stroke.

Methods: English and Chinese electronic databases were searched up to July 2021. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane's risk-of-bias tool. Meta-analysis was performed using RevMan 5.4.

Results: A total of 488 patients from 16 RCTs were included. The results showed that (1) the meta-analysis of BCI-combined treatment on the improvement of the upper limb function showed statistical significance [standardized mean difference (SMD): 0.53, 95% CI: 0.26-0.80, P < 0.05]; (2) BCI treatment can improve the abilities of daily living of patients after stroke, and the analysis results are statistically significant (SMD: 1.67, 95% CI: 0.61-2.74, P < 0.05); and (3) the BCI-combined therapy was not statistically significant for the analysis of the Modified Ashworth Scale (MAS) (SMD: -0.10, 95% CI: -0.50 to 0.30, P = 0.61).

Conclusion: The meta-analysis indicates that the BCI therapy or BCI combined with other therapies such as conventional rehabilitation training and motor imagery training can improve upper limb dysfunction after stroke and enhance the quality of daily life.

Keywords: BCI; brain-computer interface; meta-analysis; stroke; upper limb dysfunction.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Peng, Wang, Liu, Zhong, Wen, Wang, Gong and Liu.

Figures

FIGURE 1
FIGURE 1
Flowchart of the trial selection process.
FIGURE 2
FIGURE 2
Graph of the risk of bias: percentage across all included studies.
FIGURE 3
FIGURE 3
Summary of the risk of bias: review authors’ judgments about each risk-of-bias item in each included study. “+,” low risk of bias; “?,” unclear risk of bias; “–,” high risk of bias.
FIGURE 4
FIGURE 4
Forest plot of the Fugl-Meyer Assessment (FMA) score to evaluate the effect of brain-computer interface (BCI) on upper limb dysfunction after stroke.
FIGURE 5
FIGURE 5
Forest plot of the FMA score after omitting Xianwen Xiang’s study to evaluate the effect of BCI on upper limb dysfunction after stroke.
FIGURE 6
FIGURE 6
Forest plot of the Modified Barthel Index (MBI) score to evaluate the effect of BCI on upper limb dysfunction after stroke.
FIGURE 7
FIGURE 7
Modified Ashworth Scale (MAS) to evaluate the effect of BCI on upper limb dysfunction after stroke.

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