Repeated use of brain-computer interfaces (BCIs) providing contingent sensory feedback of brain activity were recently proposed as a rehabilitation approach to restore motor function after stroke or spinal cord lesions. However, there are only a few clinical studies that investigate feasibility and effectiveness of such an approach. Here we report on a placebo-controlled, multicenter clinical trial that investigated whether stroke survivors with severe upper limb (UL) paralysis benefit from 10 BCI training sessions each lasting up to 40 minutes. A total of 74 patients participated: median time since stroke is 8 months, 25% and 75% quartiles [3.0; 13.0]; median severity of UL paralysis is 4.5 points [0.0; 30.0] as measured by the Action Research Arm Test , ARAT, and 19.5 points [11.0; 40.0] as measured by the Fugl-Meyer Motor Assessment, FMMA. Patients in the BCI group (n=55) performed motor imagery of opening their affected hand. Motor imagery-related brain electric activity was translated into contingent hand exoskeleton-driven opening movements of the affected hand. In a control group (n=19), hand exoskeleton-driven opening movements of the affected hand were independent of brain electric activity. Evaluation of the UL clinical assessments indicated that both groups improved, but only the BCI group showed an improvement in the ARAT’s grasp score from 0 [0.0; 14.0] to 3.0 [0.0; 15.0] points (p<0.001) and pinch scores from 0.0 [0.0; 7.0] to 1.0 [0.0; 12.0] points (p<0.001). Upon training completion, 21.8% (36.4%) of the patients in the BCI group improved their ARAT (FMMA) scores. The corresponding numbers for the control group were 5.3% (ARAT) and 15.8% (FMMA). These results suggests that adding BCI control to exoskeleton-assisted physical therapy can improve post-stroke rehabilitation outcomes. Both maximum and mean values of the percentage of successfully decoded imagery-related EEG activity, were higher than chance level. A correlation between the classification accuracy and the improvement in the upper extremity function was found. An improvement of motor function was found for all patients independently of duration, severity and location of the stroke. Clinical trial registration number: NCT02325947.

Background: Motor imagery (MI) is the mental performance of movement without muscle activity. It is generally accepted that MI and motor performance have similar physiological mechanisms. Purpose: To investigate the activity and excitability of cortical motor areas during MI in subjects who were previously trained with an MI-based brain-computer interface (BCI). Subjects and methods: Eleven healthy volunteers without neurological impairments (mean age, 36 years; range: 24–68 years) were either trained with an MI-based BCI (BCI-trained, n = 5) or received no BCI training (n = 6, controls). Subjects imagined grasping in a blocked paradigm task with alternating rest and task periods. For evaluating the activity and excitability of cortical motor areas we used functional MRI and navigated transcranial magnetic stimulation (nTMS). Results: fMRI revealed activation in Brodmann areas 3 and 6, the cerebellum, and the thalamus during MI in all subjects. The primary motor cortex was activated only in BCI-trained subjects. The associative zones of activation were larger in non-trained subjects. During MI, motor evoked potentials recorded from two of the three targeted muscles were significantly higher only in BCI-trained subjects. The motor threshold decreased (median = 17%) during MI, which was also observed only in BCI-trained subjects. Conclusion: Previous BCI training increased motor cortex excitability during MI. These data may help to improve BCI applications, including rehabilitation of patients with cerebral palsy.

The neurophysiological prerequisites for the development and operation of the brain-computer interfaces (BCI) that allow cerebral electrical signals alone to control external technical devices are considered. A BCI based on the discrimination of the EEG patterns related to imagery of extremity movements is described. The possibility of the rehabilitation of patients with motor disorders by means of the BCI based on motor imagery and the exoskeleton controlled by it is discussed.

In this review, we focused on the applicability of artificial intelligence (AI) for opportunistic abdominal aortic aneurysm (AAA) detection in computed tomography (CT). We used the academic search system PubMed as the primary source for the literature search and Google Scholar as a supplementary source of evidence. We searched through 2 February 2022. All studies on automated AAA detection or segmentation in noncontrast abdominal CT were included. For bias assessment, we developed and used an adapted version of the QUADAS-2 checklist. We included eight studies with 355 cases, of which 273 (77%) contained AAA. The highest risk of bias and level of applicability concerns were observed for the “patient selection” domain, due to the 100% pathology rate in the majority (75%) of the studies. The mean sensitivity value was 95% (95% CI 100–87%), the mean specificity value was 96.6% (95% CI 100–75.7%), and the mean accuracy value was 95.2% (95% CI 100–54.5%). Half of the included studies performed diagnostic accuracy estimation, with only one study having data on all diagnostic accuracy metrics. Therefore, we conducted a narrative synthesis. Our findings indicate high study heterogeneity, requiring further research with balanced noncontrast CT datasets and adherence to reporting standards in order to validate the high sensitivity value obtained.