Jul 2026· Acupuncture & Electro-Therapeutics Research: International Journal of Integrated Medicine· 0 citations· 8 references
TL;DR
The combination of visual-guided BCI and FES may represent a promising adjunctive rehabilitation approach for stroke patients with severe motor impairment, particularly for those who are unable to actively participate in conventional rehabilitation.
Abstract
Stroke is one of the leading causes of death and disability worldwide. Upper extremity motor deficits frequently persist after stroke, leading to significant functional limitations and dependence in daily activities. In recent years, brain–computer interface (BCI) technologies combined with functional electrical stimulation (FES) have been explored as innovative rehabilitation tools for enhancing motor recovery.
We report three hemiplegic patients who underwent a visual-guided BCI combined with FES program, in addition to conventional rehabilitation. Each session consisted of a 30-min preparation and a 30-min treatment phase, five times a week for a total of 24 sessions. During the treatment phase, FES was triggered only when motor imagery-related EEG patterns were detected, enabling real-time patient engagement. Clinical outcomes, including Brunnstrom stages, Fugl-Meyer Assessment (FMA), and Barthel Index scores, were evaluated before and after the intervention. Improvements in upper extremity motor function and daily living activities were observed in all three cases, particularly in wrist and hand motor control.
The combination of visual-guided BCI and FES may represent a promising adjunctive rehabilitation approach for stroke patients with severe motor impairment, particularly for those who are unable to actively participate in conventional rehabilitation. However, these preliminary findings should be interpreted cautiously, and further randomized controlled trials with larger sample sizes are required to validate their clinical efficacy.
Stroke is a leading cause of severe long-term disability, and foot drop is a common post-stroke gait impairment that may reduce toe clearance, increasing the risk of toe contacts and, in turn, trip-related falls. This case series evaluated the novel combination of transcranial direct current stimulation (tDCS), functional electrical stimulation (FES) to the tibialis anterior, and physical therapy training to improve minimum toe clearance (MTC) in individuals with chronic stroke. The rationale for this combined approach was that tDCS may prime the motor cortex and enhance neuroplastic responsiveness, while FES provides task-specific peripheral stimulation to the dorsiflexors during gait-related training, potentially increasing MTC and minimizing toe drag. Four individuals with chronic stroke participated in an 8-week treatment program with sessions twice a week. Assessments were conducted at baseline, 4 weeks, and 8 weeks. Participant 1 started with tDCS alone for 4 weeks, then added FES for the remaining 4 weeks. Participant 2 began with FES for the first 4 weeks, and tDCS was added for the remaining 4 weeks. Participants 3 and 4 received both tDCS and FES throughout the entire 8-week program. Participants 1 (58-year-old female) and 4 (42-year-old male) showed no active ankle dorsiflexion at baseline, while participants 2 (66-year-old male) and 3 (36-year-old male) had a grade of 2 out of 5 for ankle dorsiflexion strength at baseline. Toe clearance and functional outcomes were collected at each assessment. Participants 1 and 4 demonstrated no meaningful change in MTC, whereas participants 2 and 3 both showed modest improvements. Among these responders, MTC increased by an average of 0.63 cm. These findings suggest that combining cortical neuromodulation with localized FES and physical therapy may improve toe clearance in select individuals with chronic stroke. However, because tibialis anterior activation was not directly measured, it remains unclear whether the observed changes were due to improved dorsiflexor activation or other compensatory gait strategies.
Sylvester Carter, G. Thielman· Journal of Medical Cases· 0 citations
Overall, the certainty of evidence was low to very low, downgraded primarily for these risk of bias concerns, severe imprecision (due to small sample sizes), and potential publication bias.
Yu Qin, Mei-xuan Li, Yan-fei Li et al.· Cochrane Database of Systema...· 0 citations
Analysis of BCI rehabilitation technologies shows that each paradigm has its own advantages for different patient groups, and future research directions including intelligent adaptive optimization, hybrid system integration, remote rehabilitation, unified evaluation criteria and large-scale clinical trials can help the clinical translation of BCI rehabilitation technologies.
Lujin Lyu· Theoretical and Natural Scie...· 0 citations
The importance of combining neurophysiological assessments with rTMS to better understand post-stroke recovery mechanisms and support the development of more targeted rehabilitation strategies is highlighted.
Devisree Dhanachezhiyan, S. Ramakrishnan, Deepak Menon et al.· Academia Neuroscience and Br...· 0 citations
The neurophysiological basis of EEG-BCI and three major rehabilitation paradigms are outlined, including motor imagery with physical feedback, motor imagery with virtual/multisensory feedback, and the steady-state visual evoked potential (SSVEP)-driven paradigm.
Wang Peng, Yang Yang, Juehan Wang et al.· Topics in Stroke Rehabilitat...· 0 citations
After discharge, many stroke patients are still in a period of active neural recovery. However, the amount of supervised rehabilitation usually decreases once they return home. This mismatch between ongoing brain plasticity and reduced therapy may affect upper limb recovery. This study examined whether a movement-responsive wearable stimulation system used at home is related to differences in upper limb motor recovery compared with usual home-based rehabilitation.
A prospective controlled study was conducted with 351 patients in the subacute stage after stroke. Participants were randomly allocated using a computer-generated sequence to either a wearable stimulation group (n = 176) or a conventional home rehabilitation group (n = 175). Upper limb motor function was assessed using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) at discharge (T0), 1 month (T1), and 3 months (T2).
FMA-UE scores increased over time in both groups. However, the pattern of change differed between groups (group × time interaction, F = 28.34,
p
< .001). At 3 months, the mean FMA-UE score was 58.2 ± 7.5 in the wearable group and 46.1 ± 9.2 in the control group. Within the wearable group, higher device use was associated with greater motor improvement (r = 0.72). The between-group difference at 3 months corresponded to a large effect size (Cohen’s d = 1.4).
These findings suggest that movement-contingent stimulation may support motor recovery by providing feedback aligned with voluntary effort during daily activities. This approach may help sustain engagement during the post-discharge period when supervised therapy is reduced.
Use of a movement-responsive wearable stimulation system during home-based rehabilitation was associated with improved upper limb motor recovery during the subacute stage after stroke.
Sanghee Kim· The Open Public Health Journ...· 0 citations
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