Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke

Masahiko Mukaino, Takashi Ono, Keiichiro Shindo, Toshiyuki Fujiwara, Tetsuo Ota, Akio Kimura, Meigen Liu, Junichi Ushiba

Research output: Contribution to journalArticlepeer-review

89 Citations (Scopus)


Objective: Brain computer interface technology is of great interest to researchers as a potential therapeutic measure for people with severe neurological disorders. The aim of this study was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using an A-B-A-B withdrawal single-subject design. Methods: A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity. In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related cortical potential was observed in the electroencephalogram. Results: The subject initially showed diffuse functional magnetic resonance imaging activation and small electroencephalogram responses while attempting finger movement. Epoch A was associated with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone was observed. Conclusion: These results indicate that self-directed training with a brain computer interface may induce activity-dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.

Original languageEnglish
Pages (from-to)378-382
Number of pages5
JournalJournal of rehabilitation medicine
Issue number4
Publication statusPublished - 2014


  • Brain computer interface
  • Hemiparesis
  • Neuromuscular electrical stimulation
  • Rehabilitation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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