Knowledge Vault 3/70 - G.TEC BCI & Neurotechnology Spring School 2024 - Day 8
Bridging science and neurotechnology to neurorehabilitation:
BCI training for neurological disorders
Jorge Alves, Centro Cerebro, recoveriX Braga (PT)
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Concept Graph & Resume using Claude 3 Opus | Chat GPT4 | Llama 3:

graph LR classDef jorge fill:#f9d4d4, font-weight:bold, font-size:14px; classDef neurorehab fill:#d4f9d4, font-weight:bold, font-size:14px; classDef tech fill:#d4d4f9, font-weight:bold, font-size:14px; classDef stroke fill:#f9f9d4, font-weight:bold, font-size:14px; classDef bci fill:#f9d4f9, font-weight:bold, font-size:14px; A[Jorge Alves] --> B[Centro Cerebro
director, Braga, Portugal. 1] A --> C[Neurorehab: optimize function,
independence in neurological disorders. 2] C --> D[Neurotechnology time has come,
needs validation, acceptance. 3] C --> E[1B+ affected by
neurological diseases worldwide. 4] C --> F[Tech advances: robotics, brain
stimulation, neural interfaces. 5] C --> G[Many neurorehab techs lack
validation, acceptance. 6] A --> H[BCIs: improve outcomes in
chronic stroke patients. 7] H --> I[Recoverix BCI: efficacy for
stroke function, spasticity, walking. 8] A --> J[Portugal: high stroke incidence,
prevalence, rising costs. 9] J --> K[2001: guidelines for rapid
stroke transport to units. 10] J --> L[Stroke 'green route' had
low usage despite delays. 11] J --> M[New systems need awareness,
education, evaluation, strategy. 12] J --> N[Portugal: integrated stroke care
network, reduce acute costs. 13] N --> O[Inequalities in stroke care
access despite integrated network. 14] J --> P[Inpatient rehab + home: no
convincing benefit vs usual. 15] A --> Q[Centro Cerebro: Recoverix in
Portugal, innovation focus. 16] Q --> R[Case A: 10yr stroke,
improved grasp post-Recoverix. 17] Q --> S[Case B: Improved head
control, self-feeding, less tremor. 18] Q --> T[Case C: Regained holding
objects, cutting food, walking. 19] Q --> U[Case D: Subacute stroke,
regained writing, leg function. 20] Q --> V[Other cases: gains in
reaching, grasping post-Recoverix. 21] A --> W[BCI: address unmet needs,
improve outcomes in stroke. 22] W --> X[BCI: neuroplasticity interventions,
motivation, comprehensive approach. 23] W --> Y[BCI enriches rehab, humanized
care adjunct, not panacea. 24] W --> Z[Use evidence-based BCIs like
Recoverix, not assume panacea. 25] A --> AA[Tech in brain health:
access, outcomes, decisions. 26] AA --> AB[Centro Cerebro: EMG-controlled
robotics, good results. 27] AA --> AC[Recoverix: control FES, avatar,
easier than robotics. 28] AA --> AD[Explore BCI for phantom
limb pain in amputees. 29] AA --> AE[Some combined Recoverix with
other rehab, effects unclear. 30] class A,B jorge; class C,D,E,F,G neurorehab; class H,I,W,X,Y,Z bci; class J,K,L,M,N,O,P stroke; class AA,AB,AC,AD,AE tech;


1.- Jorge Alves is the director of Centro Cerebro, a brain health center in Braga, Portugal that uses a multidisciplinary approach.

2.- The goal of neurorehabilitation interventions is to optimize functioning and independence in daily activities for individuals with neurological disorders.

3.- The time for neurotechnology in neurorehabilitation has come, but many approaches still need clinical validation and are not widely accepted.

4.- Over 1 billion people worldwide are affected by neurological diseases, a common cause of adult disability, with frequent lack of complete recovery.

5.- Technological advances being researched include robotic devices, non-invasive brain stimulation like TMS and tDCS, and neural interfaces using EEG.

6.- Despite decades of technological development, many neurorehab technologies lack clinical validation and acceptance due to limited research on uptake factors.

7.- Brain-computer interfaces show promise for improving outcomes in chronic stroke patients who have exhausted other rehabilitation options.

8.- There is evidence supporting the efficacy of the Recoverix BCI system for upper/lower limb function, spasticity, and walking speed in stroke.

9.- Portugal has a high incidence and prevalence of stroke, with rising healthcare costs. Incidence is around 50,000 and prevalence 76,000 per year.

10.- In 2001, Portugal approved guidelines for rapid transport of acute stroke victims to stroke units, allowing faster hospital arrival times.

11.- However, the stroke rapid transport "green route" system had low usage in municipalities despite improving delays, not translating to desired results.

12.- Implementing new systems requires ongoing awareness, education, evaluation and a comprehensive strategy to address barriers, as seen with the stroke system.

13.- Portugal has a network of continuous integrated stroke care aiming to reduce costly acute care through community care and home rehabilitation.

14.- Studies show ongoing inefficiencies and inequalities in access to stroke care in Portugal despite the integrated network and patient satisfaction.

15.- Combining inpatient stroke rehab with home support showed no convincing improvement over usual rehab services in a randomized controlled trial.

16.- Centro Cerebro implemented Recoverix in Portugal, building on their technological innovation and focus on improving clinical results despite awareness challenges.

17.- Case A: Chronic stroke patient, 10+ years post-stroke, improved on Box & Blocks and Fugl-Meyer after 25 Recoverix sessions, regaining cube grasping.

18.- Case B: Chronic stroke patient improved head control, upper limb fine motor control, self-feeding and reduced tremor after 25 Recoverix sessions.

19.- Case C: Chronic stroke patient regained ability to hold objects, cut food, and was more confident walking after 25 Recoverix sessions.

20.- Case D: Subacute stroke patient (<1 year) regained writing ability and improved lower limb function after 50 Recoverix + PT sessions.

21.- Other cases also demonstrated gains in reaching and grasping objects after Recoverix in young and older chronic stroke patients.

22.- BCI is a neurorehabilitation tool that can address unmet needs in patient-centered stroke care and improve clinical outcomes even chronically.

23.- BCI provides a way to deliver neuroplasticity-oriented interventions, increase patient motivation, and offer a comprehensive approach, especially for chronic patients.

24.- BCI can enrich rehab sessions and provide an adjunct in humanized care, but technology alone will not solve all neurological cases.

25.- It's critical to rely on evidence-based BCI interventions like Recoverix rather than assuming the technology is a panacea.

26.- Technology is being applied in brain health to extend therapy access, improve outcomes, and support clinical decision making.

27.- Centro Cerebro has experience using EMG to control robotic signals, achieving good results and clear movements in patients.

28.- They use the Recoverix system to control an FES device and virtual avatar, which is often easier and more practical than robotics.

29.- BCI interventions are also being explored for phantom limb pain in amputees, though Centro Cerebro has not used Recoverix for this.

30.- Some of their stroke patients combined Recoverix with other neurological rehab. Potential summation effects are not yet fully clarified.

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