Effects of a Virtual Reality-based Brain-Machine Interface Protocol in Spinal Cord Injury
Brain Information Transfer Dynamics and Neurorehabilitation Effects of a Virtual Reality-based Brain-Machine Interface Protocol in Spinal Cord Injury
Spinal cord injury (SCI) is a highly debilitating pathology, associated with the loss of sensorimotor functions, autonomy and quality of life. Although there is currently no cure, brain-machine interfaces (BMI) have been used as a method of SCI rehabilitation. BMIs use neurophysiological signals recorded by techniques such as electroencephalography (EEG) to produce a response in a device. Recently, BMIs have achieved clinically relevant improvements in several neuropathologies. However, the biological basis of these therapeutic protocols is yet to be studied, which is extremely important to improve their effectiveness.
Therefore, in this study it is applyed an improved BMI protocol by combination with virtual reality (VR), sensory feedback (visual, auditory, and tactile), and/or exoskeleton to characterize in detail the dynamics of information transfer between the various participants' brain regions (primary objective of the overall study, which involves participants with and without SCI), and improve the rehabilitation of SCI patients. For this, the neurophysiological signals obtained by EEG will be studied, with particular interest in the altered activity that correlates with relevant clinical improvements in the rehabilitation of SCI patients.
At the beginning of the study, the following data will be collected from the participant: age, gender; specifically for participants with SCI, data associated with the injury will also be collected; level and type of injury, time post-injury, functional classification, neurological manifestations, e.g. neuropathic pain.
During the study, the participant will be monitored weekly in a total of 12 sessions, each with an expected duration of one to two hours. In these sessions, the participant will perform a 'BMI protocol': they will move a virtual avatar using motor imagery (thinking about movement) in VR, with sensory feedback provided by VR equipment and tactile sleeves. Participants without SCI will also be able to wear an exoskeleton (ExoAtlet). The VR software was developed by the research group and is locally installed on a computer for exclusive use for the implementation of this BMI protocol. It is important to note that the software operates without a network connection and does not collect any type of personal data. The participants' brain activity will be recorded by the non-invasive EEG technique, while the participant is performing the BMI protocol, in which they will have to perform mental tasks such as walking and resting. Each session has three blocks: a first one for the participant's familiarization with the virtual scenario and/or exoskeleton; and the rest to train and carry out the tasks.
At the end, questionnaires will be carried out to assess comfort or possible undesirable effects during the VR experience (e.g., fatigue or nausea) and the participant will be given the opportunity to report their experience during the session. The EEG data from subsequent sessions will be analyzed and compared over time to identify changes in the participants' brain activity promoted by this rehabilitation protocol. Blood samples will also be collected at the beginning and end of the study (1st and 12th session), to evaluate molecules potentially associated with rehabilitation. These samples, anonymized at the end of their participation in this study, will be preserved in the Institute of Biomedicine (iBiMED, University of Aveiro) Biobank for 20 years, under the responsibility of the principal investigators, to be used in the present study. Their samples and anonymized data may be used in other future studies of the same scope, but such use will always require consent from the responsible ethics committee.
Participants with SCI will be asked about the evolution of neuropathic pain (if any) with different pain scales. At the beginning and end of the study (1st and 12th session), the standard neurological and functional classification of the lesion will be performed by physicians/therapists, according to the rehabilitation center's routine. Three months after being discharged from the center, during the revisit consultation, the clinical data described here will be collected again.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Aveiro, Portugal, 3810-193
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro
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Vila Nova de Gaia, Portugal, 4405-565
- Centro de Reabilitação do Norte (CRN) Dr. Ferreira Alves, Unidade Local de Saúde de Gaia/Espinho
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
- Any gender
- Age between 18 and 65
- Able to follow instructions and communicate verbally in Portuguese (or english for able bodied volunteers)
For the spinal cord injury group:
- American Spinal Injury Association - ASIA - Impairment Scale (AIS) grade A, B, or C
- Traumatic
- Subacute condition
- With upper limb dexterity to manipulate virtual reality controlers
Exclusion Criteria:
- Pregnant/breastfeeding women
- Disability/neurological condition that may interfere with tasks or measurements (e.g., cognitive impairment, dementia, brain injury)
- Physical injury that prevents the use of the equipment (e.g., limb amputation)
- History of severe psychiatric illness
- Inability to decide autonomously
- Conditioned binocular vision
- Photosensitive epilepsy
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Ciência básica
- Alocação: Não randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Comparador Ativo: I - Complete SCI
Participants with complete SCI who undergo the BMI protocol plus the rehabilition center intervention
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The participants will perform a virtual reality (VR)-based brain-machine interface (BMI) protocol: they will move a virtual avatar using motor imagery (thinking about movement) in an immersive VR, with sensory feedback provided by VR equipment and thermo-tactile sleeves.
The VR software was developed by the research group and is locally installed on a computer for exclusive use for the implementation of this BMI protocol.
The participants will have to perform tasks such as walking and resting in the virtual environment according to a presented visual cue.
Each session has three blocks: a first one for the participant's familiarization with the virtual scenario; and the remaining to train and carry out the tasks.
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Comparador Ativo: I - Incomplete SCI
Participants with incomplete SCI who undergo the BMI protocol plus the rehabilition center intervention
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The participants will perform a virtual reality (VR)-based brain-machine interface (BMI) protocol: they will move a virtual avatar using motor imagery (thinking about movement) in an immersive VR, with sensory feedback provided by VR equipment and thermo-tactile sleeves.
The VR software was developed by the research group and is locally installed on a computer for exclusive use for the implementation of this BMI protocol.
The participants will have to perform tasks such as walking and resting in the virtual environment according to a presented visual cue.
Each session has three blocks: a first one for the participant's familiarization with the virtual scenario; and the remaining to train and carry out the tasks.
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Comparador Ativo: Able Bodied
Able body participants who undergo the BMI protocol
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The participants will perform a virtual reality (VR)-based brain-machine interface (BMI) protocol: they will move a virtual avatar using motor imagery (thinking about movement) in an immersive VR, with sensory feedback provided by VR equipment and thermo-tactile sleeves.
The VR software was developed by the research group and is locally installed on a computer for exclusive use for the implementation of this BMI protocol.
The participants will have to perform tasks such as walking and resting in the virtual environment according to a presented visual cue.
Each session has three blocks: a first one for the participant's familiarization with the virtual scenario; and the remaining to train and carry out the tasks.
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Sem intervenção: NI - Complete SCI
Participants with complete SCI who only receives the rehabilition center intervention
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Sem intervenção: NI - Incomplete SCI
Participants with incomplete SCI who only receives the rehabilition center intervention
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Neural Activity
Prazo: At each session, from enrollment to the end of participation, at approximately 6 weeks
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Neural activity will be recorded with 16-channel electroencephalography (EEG) throughout the sessions to describe its evolution in response to the intervention (brain-machine interface protocol).
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At each session, from enrollment to the end of participation, at approximately 6 weeks
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ISNCSCI
Prazo: Outcome assessed upon admission at the rehabilitation center and re-assessed after up to 12 weeks at discharge. Discharge from the center depends on the patient's individual circumstances (e.g., individual progression, heath facilty transfer).
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Measurement of the sensorimotor function at the beginning and at the end.
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Outcome assessed upon admission at the rehabilitation center and re-assessed after up to 12 weeks at discharge. Discharge from the center depends on the patient's individual circumstances (e.g., individual progression, heath facilty transfer).
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Slot Blot/ELISA for Targeted Molecular Analysis
Prazo: Outcome assessed upon enrollment in the study and re-assessed after up to 12 weeks at completion of participation. Completion depends on the patient's individual circumstances (e.g., complications from any cause).
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Biologic samples (e.g., blood, saliva, urine, etc.) will be collected at enrollment and completion of participation in the study (see Time Frame).
They will be processed and targeted molecular markers will be quantified using tools, such as Slot Blot and Ezyme-Linked Immunosorbent Assay (ELISA), to be correlated with the other neural and clinical outcomes.
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Outcome assessed upon enrollment in the study and re-assessed after up to 12 weeks at completion of participation. Completion depends on the patient's individual circumstances (e.g., complications from any cause).
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FTIR for Untargeted Molecular Analysis
Prazo: Outcome assessed upon enrollment in the study and re-assessed after up to 12 weeks at completion of participation. Completion depends on the patient's individual circumstances (e.g., complications from any cause).
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Biologic samples (e.g., blood, saliva, urine, etc.) will be collected at enrollment and completion of participation in the study (see Time Frame).
They will be processed and Fourier Transform-Infrared (FTIR) spectroscopy will be used to discover novel molecular markers of rehabilitation.
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Outcome assessed upon enrollment in the study and re-assessed after up to 12 weeks at completion of participation. Completion depends on the patient's individual circumstances (e.g., complications from any cause).
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Chronic Pain
Prazo: At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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If present, chronic pain (either nociceptive or neurophatic) will be evaluated through four different scales: visual analog scale (VAS), numerical rating scale (NRS), verbal pain scale, and faces pain scale.
Non-numerical assessments (i.e., verbal and faces pain scales) will be then converted to numbers in order to report the average pain score.
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At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Intervention Side Effects
Prazo: At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Side effects will be measured through the Simulator Sickness Questionnaire.
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At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Embodiment
Prazo: At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Sense of embodiment towards the virtual avatar and comfort during the experince will be measured using an adaptation of the Embodiment Questionnaire.
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At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Independence Measure
Prazo: Outcome assessed upon admission at the rehabilitation center and re-assessed after up to 12 weeks at discharge. Discharge from the center depends on the patient's individual circumstances (e.g., individual progression, heath facilty transfer).
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Independence will be measured using 4th version of the Spinal Cord Independence Measure (SCIM IV)
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Outcome assessed upon admission at the rehabilitation center and re-assessed after up to 12 weeks at discharge. Discharge from the center depends on the patient's individual circumstances (e.g., individual progression, heath facilty transfer).
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Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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BMI Performance
Prazo: At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Brain-machine interface (BMI) classification performance will be measured and compared against neural data and participant reports.
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At each session, from enrollment to the end of the intervention, approximatly 6 weeks.
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Colaboradores e Investigadores
Patrocinador
Publicações e links úteis
Publicações Gerais
- Pais-Vieira C, Figueiredo JG, Perrotta A, Matos D, Aguiar M, Ramos J, Gato M, Poleri T, Pais-Vieira M. Activation of a Rhythmic Lower Limb Movement Pattern during the Use of a Multimodal Brain-Computer Interface: A Case Study of a Clinically Complete Spinal Cord Injury. Life (Basel). 2024 Mar 16;14(3):396. doi: 10.3390/life14030396.
- Pais-Vieira C, Gaspar P, Matos D, Alves LP, da Cruz BM, Azevedo MJ, Gago M, Poleri T, Perrotta A, Pais-Vieira M. Embodiment Comfort Levels During Motor Imagery Training Combined With Immersive Virtual Reality in a Spinal Cord Injury Patient. Front Hum Neurosci. 2022 May 20;16:909112. doi: 10.3389/fnhum.2022.909112. eCollection 2022.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Estimado)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
- Manifestações Neurológicas
- Doenças do Sistema Nervoso Central
- Doenças do Sistema Nervoso
- Ferimentos e Lesões
- Trauma, Sistema Nervoso
- Doenças da Medula Espinhal
- Paralisia
- Condições Patológicas, Sinais e Sintomas
- Sinais e sintomas
- Lesões da Medula Espinhal
- Paraplegia
- Equipamentos e suprimentos
- Equipamento e suprimentos elétricos
- Interfaces Cérebro-Computador
Outros números de identificação do estudo
- 16-CE-ICVS/CAC-EMHA/11.06.2024
- 2023.02051.BD (Número de outro subsídio/financiamento: Fundação para a Ciência e Tecnologia, I.P. (FCT))
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