A pilot study on the electrophysiological monitoring of patient's engagement in post-stroke physical rehabilitation

Introduction: This study discusses the feasibility of an electrophysiological monitor for patient engagement during rehabilitation sessions. While patient engagement has a significant clinical role, it is not obvious how its real-time monitoring could be used. Objective: We designed this study to provide further support for the feasibility of such a tool based on the Brain Engagement Index (BEI), and to discuss clinical usefulness and its evaluation. Methods: The study involved 30 patients during post-stroke rehabilitation. Each patient underwent two sessions with BEI monitoring. In one session the therapist received real-time feedback from the monitor and in the other he did not. The BEI was compared to video-based evaluation of temporary functional change from the session start to its end and with a rater-based evaluation of the level of engagement evoked by the exercises in the session. Results: Irrespective of whether feedback is used, there is association between BEI and temporary functional change as well as with evaluated engagement. Furthermore, the contribution of the BEI monitor to rehabilitation may be demonstrated. Conclusions: It would be challenging to establish directly the monitor's contribution in large-scale studies. Nevertheless, it might be sufficient to demonstrate that the monitor provides important information regarding patient engagement.