Brain-Computer Interface Combined with Functional Electrical Stimulation for Post-Stroke Upper Limb Motor Recovery: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis included 12 randomized controlled trials (619 participants) evaluating brain-computer interface-driven functional electrical stimulation (BCI-FES) for upper-limb rehabilitation after stroke. Compared with control interventions, BCI-FES improved Fugl-Meyer Assessment for the upper extremity scores (MD = 5.82, 95% CI 3.04-8.59, p < 0.00001; I 2 = 39%). Benefits were larger in subacute stroke (MD = 8.45). Secondary measures also improved, and no serious adverse events were reported. Evidence certainty was moderate; variation in protocols and limited evidence preclude definitive recommendations about treatment parameters.

Key findings

• Across 12 RCTs (n = 619), BCI-FES improved FMA-UE scores versus controls (MD = 5.82, 95% CI 3.04-8.59, p < 0.00001; I 2 = 39%).
• The estimated benefit was larger in subacute stroke (MD = 8.45).
• ARAT, WMFT, and MBI outcomes improved; no serious adverse events were reported.
• Dynamic-threshold paradigms, motor imagery, and several higher-dose or stimulation features were associated with larger effects, but evidence was limited.

Why it matters

The pooled findings suggest BCI-FES can improve upper-limb motor recovery after stroke, with a potentially greater effect in subacute patients. This offers a quantitative overview of an emerging rehabilitation approach and reports no serious adverse events in the included trials. However, protocol variability and limited evidence for specific stimulation and training parameters mean the results do not establish an optimal regimen.

What to keep in mind

The review reports substantial variability in stimulation parameters and task designs; evidence for protocol-specific effects is limited and based on few studies. The authors state that larger multicenter RCTs are needed.