According to the World Health Organization (WHO), cardiovascular diseases are the number one cause of mortality worldwide, including neurological conditions and cerebrovascular diseases. It is expected that by 2025, 1.5 million European people will suffer a stroke each year,  making the event of a stroke a major cause of disability worldwide. That’s why ISR researchers at LaSEEB, in partnership with NeuroRehabLab of the University of Madeira, are working towards creating neuro-rehabilitation systems that help stroke survivors with functional impairments. 

In NeurAugVR, an FCT funded project, the goal is to use virtual reality (VR) to increase neuroplasticity and create new networks in the brain. Patients who have a lesion caused by stroke may be able to relearn a movement by recruiting new areas and fostering substitute connections since there is increasing evidence that the brain remains plastic at later stages post-stroke. According to Patrícia Figueiredo, Principal Investigator, the work being currently developed combines previous research with the Interactive Technology Insititute. “ITI-LARSyS has been doing research with VR for a long time where the potential of this technology has been proven when it comes to rehabilitation. That’s why we’re working together in this LARSyS collaboration, which introduces neuroimaging as a feedback mechanism so that we can learn exactly what’s happening in the brain during these processes.”

Also a researcher on this project, Athanasios Vourvopoulos explained that by using electroencephalography (EEG)-based Brain-Computer Interfaces (BCIs) to provide feedback in virtual reality, it is possible to modulate certain patterns and adapt it to increase neuroplastic changes in the brain. “When someone has suffered a stroke they can have severe mobility and cognitive impairments. A lot of them are losing independence in everyday tasks and when you are trying to recuperate function with occupational therapy it’s important to give people real-life scenarios. What VR allows is to simulate tasks in a controlled environment and have the benefit of a real-life scenario inside the rehabilitation clinic”

He continued explaining that there are two types of brain-computer interface paradigms being used towards helping people with mobility and independence. Assistive,  in which the brain is healthy and interaction with the computer interface will serve as an assistant for the movement, for instance, to give mobility to amputees. In this case of the restorative brain-computer interface, the arm may be perfectly healthy and the problem is with the brain (e.g. stroke lesion). “This is quite challenging because with a lesion in the brain it’s harder to detect and encode brain activation into a meaningful task in virtual reality. So how can you get the activation of someone who lost that function?”

Using brain imaging allows to go deep, in terms of spatial resolution, and see which kind of changes can be evoked with brain-computer interfaces. “We are trying to change the brain. Rewire it in a healthy way. Many patients, due to the lack of movement, are using compensatory actions that might lead to undesired effects of plasticity. For example, in order for someone to reach and grab a glass, they might use more of the shoulder instead of the forearm, which could affect the way someone can re-learn a motor skill.”

What the LaSEEB team is permitting is to include this training by bypassing the central nervous system and using the brain-computer interface. This means that only by thinking about the movement people can move their virtual reality avatar. “As they move in VR in a way that they cannot in real life, and with continuous use, it can evoke new plastic changes in the brain and potentially increase the functional outcome. Thanks to the mirror neuron networks it’s possible to activate areas of the brain associated with the performance of movement, observation of movement, and motor imagery. .”

Athanasios comes from a computer science background and has been using brain-computer interfaces for almost a decade. He wanted to focus on the biomedical and bioengineering applications and what drove him into working with brain-computer interfaces was the potential for impact that it could have in people’s lives. People who can’t do some actual movements get the chance of using an alternative form of communication with the world, by means of this technology. The researcher even finds that it is very hard technology to work, but that it pays you off when you see the application level and that patients actually benefit.

So, by bringing together biomedical and computer engineering with brain-computer interaction the target is also to transport this technology to the hospital or home environment. “This will be achieved by providing portable, low-cost, and engaging training, allowing stroke patients to undertake frequent, motivating practice in convenient settings. As we learn more and more about the brain the applications of brain-computer interfaces also become wider.”

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