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Updated: Aug 4, 2025
Author Spotlight: Using Motor Imagery Brain-Computer Interface to Improve Motor and Cognitive Function in Stroke Patients
Published on: September 1, 2023
BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study
Zeanna Jadavji1,2,3, Adam Kirton1,3,4, Megan J Metzler5
1Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Insights
Brain computer interface-functional electrical stimulation (BCI-FES) is safe and feasible for children with hemiparetic cerebral palsy. This innovative therapy shows promise for improving upper extremity function in pediatric hemiparesis.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Perinatal stroke (PS) is a leading cause of hemiparetic cerebral palsy (CP), resulting in lifelong disability.
- Children with severe hemiparesis have limited therapeutic options for upper extremity function.
- Brain computer interface-activated functional electrical stimulation (BCI-FES) is a potential intervention for hemiparetic adults.
Purpose of the Study:
- To assess the safety and feasibility of BCI-FES in children with hemiparetic CP.
- To evaluate the tolerability and user experience of BCI-FES in a pediatric population.
- To establish a foundation for future clinical trials investigating BCI-FES efficacy.
Main Methods:
- A pilot clinical trial involving 13 children (ages 6-18) with MRI-confirmed PS and hemiparetic CP.
- Participants underwent two BCI sessions (training and rehabilitation) using an EEG headset and forearm extensor electrodes.
- Muscle stimulation and visual feedback were triggered by the child's imagined wrist extension, detected via EEG.
Main Results:
- No serious adverse events or dropouts were reported; common complaints included mild headache and fatigue.
- Children found the BCI-FES experience comparable to a long car ride, indicating good tolerability.
- Mean classification accuracy was high (73-79%), and Cohen's Kappa suggested BCI competency (mean=0.43).
Conclusions:
- BCI-FES is well-tolerated and feasible for children with hemiparetic cerebral palsy.
- This pilot study supports the potential of BCI-FES as a novel rehabilitation strategy for pediatric hemiparesis.
- Further clinical trials are warranted to optimize BCI-FES protocols and confirm its therapeutic efficacy.
Background:
Perinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain computer interface- activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.
Methods:
Thirteen participants (mean age = 12.2 years, 31% female) were recruited from a population-based cohort. Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6-18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded. Participants attended two BCI sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants' imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.
Results:
No serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 min with 33 min of stimulation delivered. Mean classification accuracies were (M = 78.78%, SD = 9.97) for training and (M = 73.48, SD = 12.41) for rehabilitation. Mean Cohen's Kappa across rehabilitation trials was M = 0.43, SD = 0.29, range = 0.019-1.00, suggesting BCI competency.
Conclusion:
Brain computer interface-FES was well -tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.
