Advancing Stroke Recovery Through Operant Conditioning of Corticomuscular Coherence

As stroke results in deficits spanning multiple functional domains, interventions that promote neuroplasticity-like mechanisms across brain and body systems may optimize recovery. In this perspective, we propose a rehabilitation strategy combining operant conditioning with corticomuscular coherence (CMC), a neurophysiological marker of communication between brain and muscle. CMC reflects the synchrony of descending cortical drive with spinal motor output, serving as a real-time index of volitional control. We assert that reinforcing CMC through operant conditioning can strengthen movement-related neural circuits while simultaneously engaging cognitive systems responsible for motor planning, attention, and error correction. Drawing from motor learning, systems neuroscience, and neuroengineering evidence, we outline the conceptual rationale along with the translational potential and implementation challenges of this CMC-based operant conditioning approach. We posit that this framework offers a biologically plausible strategy to strengthen residual motor capacity and restore functional integration across disrupted circuits connecting brain and body systems.