1. Evaluation of a Closed-Loop BCI-FES System on Recovery of Upper Extremity Function Based on Functionality Post Stroke: A Case Series Angela Gille, OTS and Dorothy Farrar Edwards, PhD University of Wisconsin - Madison With the advent of tPa stroke mortality is decreasing while the number of adults living with stroke related disability is increasing It has been shown that using functional electrical stimulation (FES) with visual imagery feedback can improve hand and arm function in patients with moderate stroke Studies with patients spanning the spectrum of stroke severity are necessary for occupational therapists who consider using these treatment methods This study investigated whether the upper extremity functional outcomes of persons with stroke receiving closed- loop FES-BCI treatment vary based on initial level of upper extremity impairment as determined by objective and subjective measures Four participants were evaluated and divided into high and low severity groups based on performance on the Action Research Arm Test (ARAT) Participants paired actual or attempted movement with an FES unit while receiving brain computer interface (BCI) visual feedback Participants attended 2-3 interventions sessions per week for 9 weeks Stroke Impact Scale (SIS) and Nine-Hole Pegtest (9-HPT) assessments were completed at baseline, mid intervention, final intervention, and 1 month post intervention With the advent of tPa stroke mortality is decreasing while the number of adults living with stroke related disability is increasing It has been shown that using functional electrical stimulation (FES) with visual imagery feedback can improve hand and arm function in patients with moderate stroke Studies with patients spanning the spectrum of stroke severity are necessary for occupational therapists who consider using these treatment methods This study investigated whether the upper extremity functional outcomes of persons with stroke receiving closed- loop FES-BCI treatment vary based on initial level of upper extremity impairment as determined by objective and subjective measures Four participants were evaluated and divided into high and low severity groups based on performance on the Action Research Arm Test (ARAT) Participants paired actual or attempted movement with an FES unit while receiving brain computer interface (BCI) visual feedback Participants attended 2-3 interventions sessions per week for 9 weeks Stroke Impact Scale (SIS) and Nine-Hole Pegtest (9-HPT) assessments were completed at baseline, mid intervention, final intervention, and 1 month post intervention Introduction Objectives Methods Results Conclusion Implications Acknowledgments References Continued research regarding the closed-loop FES-BCI interface is imperative Neither high impairment participant showed improvement in 9-HPT or use of affected hand scores Each participant reported improvement in ADL completion, possibly indicating improved compensatory strategies or improvement as a result of intervention Participant 1, 3, and 4 all showed low scores for fine motor activities Although Participant 3 and 4 showed improvements in affected hand use and ADL completion these results may be due to spontaneous recovery as they are only 2 and 3 months post stroke I would like to thank my mentor Dr. Dorothy Edwards for taking the time to assist me with this project. I would also like to thank Dr. Martha McCurdy for all of her effort teaching research methods. Thank you to Kira Luoma, Julie Conrad, and Jeanne Devine for their collaboration on this project The use of the closed-loop FES-BCI interface may not be beneficial when used on persons with stroke who have severely impaired upper extremity function Treatment for these persons should focus on compensatory strategies, AT, and education It is unclear whether the closed-loop FES-BCI interface results in improved fine motor skills or fine motor ADLs across severities Overall reported ADL performance continues to improve even after a year post stroke FES may be best used during times of spontaneous recovery as was shown in participants 3 and 4 It is important for therapists to use a multiple assessments to gauge functional gain. Subjective measures do not always correlate to objective performance of non-meaningful tasks such as the 9-HPT Alberts, M. 1998. tPa in acute ischemic stroke: United states experience and issues for the future, Neurology. 51(3). S53-S55 Daly, J., Chen, R., Rogers, J., :Litinas, K., Hrovat, K., & Dohring, M. (2009). Feasibility of a new application of noninvasive brain computer interface (BCI): A case study of training for recovery of volitional motor control after stroke. Journal of Neurologic Physical Therapy. 33(4). 203-211. Table 2. SIS scores on ADL questions across four timepoints. Circled in green are scores that jumped 2+ points. Circled in blue are scores representing persistent decreased fine motor ability. High Impairment: Low Impairment: Figure 1. Participant trends across baseline, mid-intervention, post- intervention, and 1 month post intervention Table 1. Participant demographics Figure 1. FES-BCI-TDU apparatus and biofeedback display. Participants create their desired movement (ie – wrist flexion). The EEG transmits the quality of this movement to the BCI. The BCI translates this information into a ball on screen for the participants to see. The higher the quality of the motor signals the closer the ball will move to the grey target.