Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

Hope Jervis-Rademeyer; Kenneth Ong; Alexander Djuric; Sarah Munce; Kristin E Musselman; Cesar Marquez-Chin

doi:10.1186/s12984-022-01107-2

Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

J Neuroeng Rehabil. 2022 Nov 23;19(1):127. doi: 10.1186/s12984-022-01107-2.

Authors

Hope Jervis-Rademeyer^{1

2}, Kenneth Ong^{2

3}, Alexander Djuric^{2

3}, Sarah Munce^{1

2

4}, Kristin E Musselman^{1

2

3}, Cesar Marquez-Chin^{5

6}

Affiliations

¹ Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
² The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
³ Department of Physical Therapy, University of Toronto, Toronto, Canada.
⁴ Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.
⁵ The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada. Cesar.Marquez@uhn.ca.
⁶ Institute of Biomedical Engineering, University of Toronto, Toronto, Canada. Cesar.Marquez@uhn.ca.

Abstract

Background: Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists' opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation.

Methods: Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach.

Results: We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists' decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST.

Conclusions: We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.

Keywords: Brain-computer interface; Functional electrical stimulation; Paralysis; Rehabilitation; Spinal cord injury; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain-Computer Interfaces*
Electric Stimulation Therapy*
Humans
Paralysis
Qualitative Research
Upper Extremity

Grants and funding

CIHR/Canada