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Updated: Apr 16, 2026

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Brain-Computer Interface Combined with Functional Electrical Stimulation for Post-Stroke Upper Limb Motor Recovery: A

Fengjiao Liang1, Xiang Chen1, Baoying Li2

  • 1School of Rehabilitation Medicine, Ministry of Education Engineering Research Center for Intelligent Rehabilitation of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Clinical EEG and Neuroscience
|April 15, 2026
PubMed
Summary
This summary is machine-generated.

Brain-computer interface-driven functional electrical stimulation (BCI-FES) aids stroke recovery by improving upper limb function, particularly in subacute patients. Further research is needed to optimize BCI-FES protocols for personalized rehabilitation.

Keywords:
brain computer interfacefunctional electrical stimulationmeta-analysisrehabilitationstrokeupper limb

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Biomedical Engineering

Background:

  • Brain-computer interface-driven functional electrical stimulation (BCI-FES) shows promise for post-stroke upper limb rehabilitation.
  • Current BCI-FES protocols exhibit significant variability, hindering definitive recommendations.
  • Evidence on optimal stimulation parameters and task designs remains insufficient.

Purpose of the Study:

  • To systematically evaluate the efficacy of BCI-FES for upper limb motor recovery in stroke patients.
  • To identify potential factors influencing BCI-FES effectiveness, including stimulation parameters and task paradigms.
  • To assess the certainty of evidence and guide future research directions.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) for randomized controlled trials (RCTs) up to September 2025.
  • Twelve RCTs involving 619 participants met the eligibility criteria, focusing on BCI-FES interventions and upper extremity Fugl-Meyer Assessment (FMA-UE) scores.
  • Random-effects meta-analyses were performed, with risk of bias assessed using the PEDro scale and evidence certainty graded with GRADE.

Main Results:

  • BCI-FES significantly improved FMA-UE scores compared to control groups (MD = 5.82, p < 0.00001), with greater effects observed in subacute stroke patients (MD = 8.45).
  • Dynamic-threshold paradigms and motor imagery tasks were associated with higher effect sizes.
  • While certain parameters (e.g., frequency >50 Hz, pulse width 150 µs, frequent sessions, shorter duration, longer intervention) trended towards larger effects, evidence is limited; secondary outcomes improved, and no serious adverse events were reported. Evidence certainty was moderate.

Conclusions:

  • BCI-FES demonstrates efficacy in promoting upper limb motor recovery post-stroke, especially in the subacute phase.
  • Specific stimulation and training features may enhance BCI-FES outcomes, but current evidence is insufficient for definitive clinical guidelines.
  • Larger multicenter RCTs are crucial for clarifying dose-response relationships and enabling biomarker-guided, personalized interventions.