Development of a brain computer interface for delivery of non-invasive brain stimulation during visuomotor task performance - A method study

The ability to walk is important for independent performance of activities of daily living and therefore determines quality of life. Consequently impairment of walking has been mentioned most frequently as the most important disabling symptom in community-dwelling stroke survivors. Walking activity requires a complex pattern of neural commands. Parts of the central nervous system motor network are the primary motor cortex, premotor areas, parietal cortex, basal ganglia, thalamus, and cerebellum. Innovative methodologies leveraging brain computer interfaces (BCI) for stroke neurorehabilitation are urgently required to reduce long-term walking disability. Neuroplastic changes, which are strongly related to relearning of disabled functions in rehabilitation, may be facilitated during BCI therapy with non-invasive multi-level electrotherapy such as neuromuscular electrical stimulation (NMES) and noninvasive brain stimulation (NIBS). We propose a multi-level electrotherapy paradigm towards motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BCI to drive NMES, the state of brain can be can be altered towards improvement of visuomotor task performance with NIBS. Therefore, this paper presents the development of a BCI for delivery of NIBS during a lower-limb visuomotor task. Some preliminary results from healthy subjects are presented additionally.