Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jan 6;22(1):1.
doi: 10.1186/s12984-024-01535-2.

Efficacy of brain-computer interface training with motor imagery-contingent feedback in improving upper limb function and neuroplasticity among persons with chronic stroke: a double-blinded, parallel-group, randomized controlled trial

Myeong Sun Kim  1   2 , Hyunju Park  1   2 , Ilho Kwon  1   2 , Kwang-Ok An  3 , Hayeon Kim  3 , Gyulee Park  1   2 , Wooseok Hyung  4 , Chang-Hwan Im  5 , Joon-Ho Shin  6   7   8
Affiliations
Randomized Controlled Trial

Efficacy of brain-computer interface training with motor imagery-contingent feedback in improving upper limb function and neuroplasticity among persons with chronic stroke: a double-blinded, parallel-group, randomized controlled trial

Myeong Sun Kim et al. J Neuroeng Rehabil. .

Abstract

Background: Brain-computer interface (BCI) technology can enhance neural plasticity and motor recovery in persons with stroke. However, the effects of BCI training with motor imagery (MI)-contingent feedback versus MI-independent feedback remain unclear. This study aimed to investigate whether the contingent connection between MI-induced brain activity and feedback influences functional and neural plasticity outcomes. We hypothesized that BCI training, with MI-contingent feedback, would result in greater improvements in upper limb function and neural plasticity compared to BCI training, with MI-independent feedback.

Methods: This randomized controlled trial included persons with chronic stroke who underwent BCI training involving functional electrical stimulation feedback on the affected wrist extensor. Primary outcomes included the Medical Research Council (MRC) scale score for muscle strength in the wrist extensor (MRC-WE) and active range of motion in wrist extension (AROM-WE). Resting-state electroencephalogram recordings were used to assess neural plasticity.

Results: Compared to the MI-independent feedback BCI group, the MI-contingent feedback BCI group showed significantly greater improvements in MRC-WE scores (mean difference = 0.52, 95% CI = 0.03-1.00, p = 0.036) and demonstrated increased AROM-WE at 4 weeks post-intervention (p = 0.019). Enhanced functional connectivity in the affected hemisphere was observed in the MI-contingent feedback BCI group, correlating with MRC-WE and Fugl-Meyer assessment-distal scores. Improvements were also observed in the unaffected hemisphere's functional connectivity.

Conclusions: BCI training with MI-contingent feedback is more effective than MI-independent feedback in improving AROM-WE, MRC, and neural plasticity in individuals with chronic stroke. BCI technology could be a valuable addition to conventional rehabilitation for stroke survivors, enhancing recovery outcomes.

Trial registration: CRIS (KCT0009013).

Keywords: Brain-computer interface; Brain-machine interface; Randomized clinical trial; Rehabilitation; Stroke.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of the Rehabilitation Hospital (NRC-2020-01-007) and registered at CRIS (KCT0009013). Participants provided informed consent before enrolment in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of participant recruitment
Fig. 2
Fig. 2
The recoveriX PRO training system
Fig. 3
Fig. 3
The recoveriX PRO session
Fig. 4
Fig. 4
Changes in MRC-WE and AROM-WE from W0 to W4. MRC-WE, Medical Research Council scale score for muscle strength in the wrist extensor; AROM-WE, active range of motion in wrist extension
Fig. 5
Fig. 5
Significant PDC values for the ipsilesional hemisphere and contralateral hemisphere in both groups. PDC, partial directed coherence
Fig. 6
Fig. 6
Repeated measures correlation analysis of the associations of changes in β-band and µ-band with MRC-WE and FMA-distal in the two groups. MRC-WE, Medical Research Council (MRC) scale score for muscle strength in the wrist extensor; FMA, Fugl-Meyer assessment
Fig. 7
Fig. 7
Individual RMT and MEP data for the two groups. RMT, resting motor threshold; MEP, motor evoked potential
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693–702. - PubMed
    1. Wolpaw JR, Millán JDR, Ramsey NF. Brain-computer interfaces: definitions and principles. Handb Clin Neurol. 2020;168:15–23. - PubMed
    1. Mane R, Chouhan T, Guan C. BCI for stroke rehabilitation: motor and beyond. J Neural Eng. 2020;17:041001. - PubMed
    1. Miao Y, Chen S, Zhang X, Jin J, Xu R, Daly I, et al. BCI-based rehabilitation on the stroke in sequela stage. Neural Plast. 2020;2020:8882764. - PMC - PubMed
    1. Pichiorri F, Morone G, Petti M, Toppi J, Pisotta I, Molinari M, et al. Brain-computer interface boosts motor imagery practice during stroke recovery. Ann Neurol. 2015;77:851–65. - PubMed

Publication types

LinkOut - more resources