Brain computer interfaces for neurorehabilitation – its current status as a rehabilitation strategy post-stroke

The idea of using brain computer interfaces (BCI) for rehabilitation emerged relatively recently. Basically, BCI for neurorehabilitation involves the recording and decoding of local brain signals generated by the patient, as he/her tries to perform a particular task (even if imperfect), or during a mental imagery task. The main objective is to promote the recruitment of selected brain areas involved and to facilitate neural plasticity. The recorded signal can be used in several ways: (i) to objectify and strengthen motor imagery-based training, by providing the patient feedback on the imagined motor task, for example, in a virtual environment; (ii) to generate a desired motor task via functional electrical stimulation or rehabilitative robotic orthoses attached to the patient's limb – encouraging and optimizing task execution as well as "closing" the disrupted sensorimotor loop by giving the patient the appropriate sensory feedback; (iii) to understand cerebral reorganizations after lesion, in order to influence or even quantify plasticity-induced changes in brain networks. For example, applying cerebral stimulation to re-equilibrate inter-hemispheric imbalance as shown by functional recording of brain activity during movement may help recovery. Its potential usefulness for a patient population has been demonstrated on various levels and its diverseness in interface applications makes it adaptable to a large population. The position and status of these very new rehabilitation systems should now be considered with respect to our current and more or less validated traditional methods, as well as in the light of the wide range of possible brain damage. The heterogeneity in post-damage expression inevitably complicates the decoding of brain signals and thus their use in pathological conditions, asking for controlled clinical trials.