Combined rTMS and virtual reality brain-computer interface training for motor recovery after stroke

N. N. Johnson, J. Carey, B. J. Edelman, A. Doud, A. Grande, K. Lakshminarayan, B. He

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59 Scopus citations


Objective. Combining repetitive transcranial magnetic stimulation (rTMS) with brain-computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS + BCI, compared to sham rTMS + BCI, on motor recovery after stroke in subjects with lasting motor paresis. Approach. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Main results. Motor improvements were observed in both real rTMS + BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. Significance. When combined, the results highlight the feasibility and efficacy of combined rTMS + BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS + BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS + BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

Original languageEnglish (US)
Article number016009
JournalJournal of neural engineering
Issue number1
StatePublished - Feb 2018

Bibliographical note

Funding Information:
We acknowledge Ann Van de Winckel, PhD, Angeliki Beyko, Claire Zurn, Taylor Streitz, and Albert You for assistance with data collection, Mo Chen, PhD for IHI analysis assistance, as well as Julie Scherber for assistance with subject recruitment. This work was supported in part by NSF DGE-1264782, NIH AT009263, EB021027, NS096761, and NSF CBET-1069104.

Publisher Copyright:
© 2018 IOP Publishing Ltd.


  • brain-computer interface
  • functional MRI
  • rehabilitation
  • repetitive transcranial magnetic stimulation
  • stroke
  • upper extremity
  • virtual reality


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