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Hybrid Brain/Neural Exoskeleton Enables Bimanual ADL Training in Routine Stroke Rehabilitation.

Annalisa Colucci1, Mareike Vermehren1, Cornelius Angerhöfer1

  • 1Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité-Universitätsmedizin Berlin, Germany (A.C., M.V., C.A., N.P., S.R.S.).

Stroke
|November 17, 2025
PubMed
Summary

This study introduces a portable brain/neural exoskeleton (B/NE) system using brain and eye signals for stroke rehabilitation. The B/NE system demonstrated effective and intuitive control, facilitating seamless integration into clinical workflows for improved motor recovery.

Keywords:
activities of daily livingbrain-computer interfaceelectroencephalographyelectrooculographymotor disordersstroke

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Area of Science:

  • Neuroscience
  • Rehabilitation Engineering
  • Biomedical Signal Processing

Background:

  • Stroke survivors often experience severe upper limb motor impairment, hindering daily activities.
  • Existing brain/neural exoskeleton (B/NE) technologies show promise for motor recovery but lack clinical integration.
  • A novel, portable B/NE system is needed to overcome integration barriers in clinical settings.

Purpose of the Study:

  • To introduce and validate a fully portable B/NE system for stroke neurorehabilitation.
  • To assess the feasibility of using brain (electroencephalography) and ocular (electrooculography) signals for controlling the B/NE.
  • To evaluate the system's integration into clinical workflows and its effectiveness in restoring bimanual activities.

Main Methods:

  • A pilot study involved 5 stroke survivors undergoing inpatient neurorehabilitation.
  • Participants completed a 1-hour training session including system setup, calibration, and B/NE-supported bimanual activities.
  • Primary outcomes included control accuracy, signal modulation reliability, and time to task initiation.

Main Results:

  • Participants achieved reliable control accuracy using both brain (83%) and ocular (100%) signals.
  • Control was intuitive, with time to initialize less than 2 seconds.
  • All participants successfully controlled the B/NE for 10 bimanual activities, with setup under 20 minutes.

Conclusions:

  • The portable B/NE system is compatible with existing clinical workflows.
  • The B/NE system is feasible for stroke neurorehabilitation, enabling effective bimanual activity restoration.
  • Seamless integration of B/NE technology into clinical practice can enhance motor recovery support for stroke survivors.