Objectives: Physical activity and cognitive training are effective to enhance cognition in older patients with mild cognitive impairment (MCI). Xbox 360 Kinect cognitive games are a combination of physical activity and cognitive training. The objective of this study was to determine the short- and long-term effects of Xbox 360 Kinect cognitive games on slowness and complexity of electroencephalography (EEG) and cognitive functions in older subjects with MCI. Materials and Methods: A clinical trial was conducted on 44 MCI subjects. Both males and females were randomized into experimental group (participated in Xbox 360 Kinect cognitive games) and control group (range of motion exercises only and no Xbox 360 Kinect cognitive games). Subjects were assessed before and after one session of game intervention for short-term effects and after 6 weeks for long-term effects. The outcome measures were the mini-mental state examination (MMSE), Montreal cognitive assessment scale (MoCA), trail making test (TMT) A and B, and slowness and complexity of EEG. Results: After one session of game intervention, delta (0.704 ± 0.025; P = 0.013), theta (0.128 ± 0.009; P = 0.00127) waves, and complexity of EEG (0.642 ± 0.042; P = 0.008) significantly improved, in eyes closed state. Whereas after 6 weeks intervention of games, delta (0.673 ± 0.029; P = 0.013), theta (0.129 ± 0.013; P = 0.002), beta2 waves (0.044 ± 0.009; P = 0.046), complexity of EEG (0.051 ± 0.042; P = 0.016), MMSE (26.25 ± 0.347 vs. 23.722 ± 0.731; P = 0.003), MoCA (25.65 ± 0.310 vs. 22.00 ± 0.504; P = 0.0001), TMT-A (1.429 ± 0.234 vs. 2.225 ± 0.259; P = 0.028), and TMT-B (2.393 ± 0.201 vs. 3.780 ± 0.195; P = 0.0001) improved significantly. These changes were not observed in the control group. Conclusion: Xbox 360 Kinect games showed beneficial effects after short- and long-term intervention on MCI subjects. These games can serve as potential therapeutic candidates for MCI.

Background: Mild cognitive impairment (MCI) is becoming an emerging problem for developing countries where there is an increase in expected age. There is no specific curative therapeutic treatment available for these patients. Objective: The objective of this study was to evaluate short and long-term changes in the electroencephalogram (EEG) parameters and cognition of MCI patients with aerobic exercises. Methods: A randomized controlled trial was conducted on 40 patients which were randomly divided into two groups, “aerobic exercise treatment group (n = 21)” and “no-aerobic control group (n = 19)”. Short-term effects of exercise were measured after single session of exercise and long-term effects were measured after an 18 sessions (6 weeks) treatment. The outcomes which were measured were, electroenphelogram paramaters (slowness and complexity of the EEG) and cognitive functions (using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and trail making test (TMT) A and B). Results: After one session of aerobic exercise there were significant improvements in slowness (delta waves; 0.678 ± 0.035 vs 0.791 ± 0.033; p = 0.015) and complexity (0.601 ± 0.051 vs 0.470 ± 0.042; p = 0.027) of the EEG in aerobic exercise treated group as compared to no-aerobic exercise group. After six weeks there were significant improvements in slowness (delta waves; 0.581 ± 0.036 vs 0.815 ± 0.025; p = 0.005) and complexity (0.751 ± 0.045 vs 0.533 ± 0.046; p = 0.001) of the EEG in the aerobic group as compared to no-aerobic group. Moreover, significant improvements were observed in the MMSE (p = 0.032), MoCA (p = 0.036), TMT-A (p = 0.005) and TMT-B (p = 0.007) in aerobic exercise group as compared to no-aerobic group. Conclusion: Aerobic exercise showed improvement in cognition after short and long-term treatment in MCI subjects and can be used as potential therapeutic candidate.

Stroke rehabilitation faces challenges in attaining enduring improvements in hand motor function and is frequently constrained by interventional limitations. This research aims to present an innovative approach to the integration of cognitive engagement within visual feedback incorporated into fully immersive virtual reality (VR) based games to achieve enduring improvements. These innovative aspects of interaction provide more functional advantages beyond motivation to efficiently execute repeatedly hand motor tasks. The effectiveness of virtual reality games incorporated with innovative aspects has been investigated for improvements in hand motor functions. A randomized controlled trial was conducted, a total of (n=56) subacute stroke patients were assessed for eligibility and (n=52) patients fulfilled the inclusion criteria. (n=26) patients were assigned to the experimental group and (n=26) patients were assigned to the control group. VR intervention involves four VR based games, developed based on hand movements including flexion/extension, close/open, supination/pronation and pinch. All patients got therapy of 24 sessions, lasting 4 days/week for a total of 6 weeks. Five clinical outcome measures were Fugl- Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index, and Stroke-Specific Quality of Life were assessed to evaluate patients’ performance. Results revealed that after therapy there was significant improvement between the groups (p<0.05) and within groups (p<0.05) in all assessment weeks in all clinical outcome measures however, improvement was observed significantly greater in the experimental group due to fully immersive VR-based games. Results indicated that cognitive engagement within visual feedback incorporated in VR-based hand games effectively improved hand motor functions.

The objective of this study was to investigate whether a single session of chiropractic care could increase strength in weak plantar flexor muscles in chronic stroke patients. Maximum voluntary contractions (strength) of the plantar flexors, soleus evoked V-waves (cortical drive), and H-reflexes were recorded in 12 chronic stroke patients, with plantar flexor muscle weakness, using a randomized controlled crossover design. Outcomes were assessed pre and post a chiropractic care intervention and a passive movement control. Repeated measures ANOVA was used to asses within and between group differences. Significance was set at p < 0.05. Following the chiropractic care intervention there was a significant increase in strength (F (1,11) = 14.49, p = 0.002; avg 64.2 ± 77.7%) and V-wave/Mmax ratio (F(1,11) = 9.67, p = 0.009; avg 54.0 ± 65.2%) compared to the control intervention. There was a significant strength decrease of 26.4 ± 15.5% (p = 0.001) after the control intervention. There were no other significant differences. Plantar flexor muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level. Further research is required to investigate the longer term and potential functional effects of chiropractic care in stroke recovery.

Brain- and muscle-triggered exoskeletons have been proposed as a means for motor training after a stroke. With the possibility of performing different movement types with an exoskeleton, it is possible to introduce task variability in training. It is difficult to decode different movement types simultaneously from brain activity, but it may be possible from residual muscle activity that many patients have or quickly regain. This study investigates whether nine different motion classes of the hand and forearm could be decoded from forearm EMG in 15 stroke patients. This study also evaluates the test-retest reliability of a classical, but simple, classifier (linear discriminant analysis) and advanced, but more computationally intensive, classifiers (autoencoders and convolutional neural networks). Moreover, the association between the level of motor impairment and classification accuracy was tested. Three channels of surface EMG were recorded during the following motion classes: Hand Close, Hand Open, Wrist Extension, Wrist Flexion, Supination, Pronation, Lateral Grasp, Pinch Grasp, and Rest. Six repetitions of each motion class were performed on two different days. Hudgins time-domain features were extracted and classified using linear discriminant analysis and autoencoders, and raw EMG was classified with convolutional neural networks. On average, 79 ± 12% and 80 ± 12% (autoencoders) of the movements were correctly classified for days 1 and 2, respectively, with an intraclass correlation coefficient of 0.88. No association was found between the level of motor impairment and classification accuracy (Spearman correlation: 0.24). It was shown that nine motion classes could be decoded from residual EMG, with autoencoders being the best classification approach, and that the results were reliable across days; this may have implications for the development of EMG-controlled exoskeletons for training in the patient’s home.

Objective: We propose a novel cue‐based asynchronous brain–computer interface(BCI) for neuromodulation via the pairing of endogenous motor cortical activity with the activation of somatosensory pathways.Methods: The proposed BCI detects the intention to move from single‐trial EEG signals in real time, but, contrary to classic asynchronous‐BCI systems, the detection occurs only during time intervals when the patient is cued to move. This cue‐based asynchronous‐BCI was compared with two traditional BCI modes (asynchronous‐BCI and offline synchronous‐BCI) and a control intervention in chronic stroke patients. The patients performed ankle dorsiflexion movements of the paretic limb in each intervention while their brain signals were recorded. BCI interventions decoded the movement attempt and activated afferent pathways via electrical stimulation. Corticomotor excitability was assessed using motor‐evoked potentials in the tibialis‐anterior muscle induced by transcranial magnetic stimulation before, immediately after, and 30 min after the intervention.Results: The proposed cue‐based asynchronous‐BCI had significantly fewer false positives/min and false positives/true positives (%) as compared to the previously developed asynchronous‐BCI. Linear‐mixed‐models showed that motor‐evoked potential amplitudes increased following all BCI modes immediately after the intervention compared to the control condition (p <0.05). The proposed cue‐based asynchronous‐BCI resulted in the largest relative increase in peak‐to‐peak motor‐evoked potential amplitudes(141% ± 33%) among all interventions and sustained it for 30 min(111% ± 33%).Interpretation: These findings prove the high performance of a newly proposed cue‐based asynchronous‐BCI intervention. In this paradigm, individuals receive precise instructions (cue) to promote engagement, while the timing of brain activity is accurately detected to establish a precise association with the delivery of sensory input for plasticity induction.