Temporal synchrony promotes motor recovery and ipsilesional cortical reorganization in BCI-based stroke rehabilitation: a randomized controlled trial.
6 affiliations
- 1Department of Sports Science, Zhejiang University, Hangzhou, 310000, China.
- 2Department of Physical Therapy, The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
- 3School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, 210029, China.
- 4Department of Sports Science, Zhejiang University, Hangzhou, 310000, China. [email protected].
- 5Department of Physical Therapy, The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, 221000, China. [email protected].
- 6Department of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China. [email protected].
Abstract
Background
The therapeutic mechanisms of brain-computer interface (BCI) rehabilitation remain partially understood. Specifically, it is unclear whether functional gains are driven primarily by active neural engagement or strictly by the temporal contingency between motor intention and sensory feedback. This study aimed to deconstruct the BCI paradigm to isolate the specific contributions of these core components to functional recovery and cortical reorganization in subacute stroke.Methods
Seventy-seven subacute stroke patients were randomized into three intervention arms. Group C (synchronous) received robotic assistance strictly contingent on real-time detection of task engagement during motor imagery; Group B (asynchronous) performed identical motor imagery tasks but received temporally uncoupled robotic assistance; and Group A (sham) received sham motor imagery detection and preset passive robotic assistance. The intervention lasted for 3 weeks. The primary clinical outcome was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores. Functional near-infrared spectroscopy (fNIRS) was included as an exploratory neuroimaging measure to provide preliminary information on cortical responses associated with the intervention.Results
Sixty-eight participants were included in the final analysis. After adjustment for baseline values, Group C showed significantly higher post-intervention FMA-UE scores than both Group A (adjusted mean difference = 7.47, 95% CI [1.94, 13.00], P = 0.004) and Group B (adjusted mean difference = 9.72, 95% CI [4.14, 15.30], P < 0.001). Group C also showed significantly higher post-intervention MBI scores than both Group A (adjusted mean difference = 21.15, 95% CI [12.49, 29.81], P < 0.001) and Group B (adjusted mean difference = 21.27, 95% CI [12.42, 30.12], P < 0.001). Exploratory neuroimaging analyses showed that only the change in ipsilesional sensorimotor cortex laterality index during motor imagery was significantly correlated with motor improvement (ρ = 0.404, P = 0.002, q = 0.012), whereas no resting-state or task-related fNIRS group comparisons remained significant after false discovery rate correction.Conclusions
Synchronous BCI training was associated with superior clinical improvement compared with asynchronous and sham conditions in subacute stroke. The benefit was observed only when robotic assistance was contingent on real-time task performance, despite all three groups receiving comparable device exposure and motor imagery instruction. The neuroimaging results remain exploratory and should be confirmed in larger studies with prospectively defined imaging endpoints. Trial registration This trial was registered under the Chinese Clinical Trial Registry (ChiCTR2400091197) and was prospectively registered on October 21, 2024. Ethics Approval: Approved by the Ethics Committee of Xuzhou Rehabilitation Hospital (XK-LSW-20241017-009).
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BibTeX
@article{wu2026temporal,
title = {{Temporal synchrony promotes motor recovery and ipsilesional cortical reorganization in BCI-based stroke rehabilitation: a randomized controlled trial.}},
author = {Yu Wu and Qiumeng Dong and Jie Chen and Cong Huang and Ming Zhang},
journal = {Journal of neuroengineering and rehabilitation},
year = {2026},
month = jul,
doi = {10.1186/s12984-026-02100-9},
url = {https://europepmc.org/article/MED/42894183},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Temporal synchrony promotes motor recovery and ipsilesional cortical reorganization in BCI-based stroke rehabilitation: a randomized controlled trial.
AU - Yu Wu
AU - Qiumeng Dong
AU - Jie Chen
AU - Cong Huang
AU - Ming Zhang
PY - 2026
DA - 2026/07/01
JO - Journal of neuroengineering and rehabilitation
DO - 10.1186/s12984-026-02100-9
UR - https://europepmc.org/article/MED/42894183
AB - Background The therapeutic mechanisms of brain-computer interface (BCI) rehabilitation remain partially understood. Specifically, it is unclear whether functional gains are driven primarily by active neural engagement or strictly by the temporal contingency between motor intention and sensory feedback. This study aimed to deconstruct the BCI paradigm to isolate the specific contributions of these core components to functional recovery and cortical reorganization in subacute stroke.Methods Seventy-seven subacute stroke patients were randomized into three intervention arms. Group C (synchronous) received robotic assistance strictly contingent on real-time detection of task engagement during motor imagery; Group B (asynchronous) performed identical motor imagery tasks but received temporally uncoupled robotic assistance; and Group A (sham) received sham motor imagery detection and preset passive robotic assistance. The intervention lasted for 3 weeks. The primary clinical outcome was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores. Functional near-infrared spectroscopy (fNIRS) was included as an exploratory neuroimaging measure to provide preliminary information on cortical responses associated with the intervention.Results Sixty-eight participants were included in the final analysis. After adjustment for baseline values, Group C showed significantly higher post-intervention FMA-UE scores than both Group A (adjusted mean difference = 7.47, 95% CI [1.94, 13.00], P = 0.004) and Group B (adjusted mean difference = 9.72, 95% CI [4.14, 15.30], P < 0.001). Group C also showed significantly higher post-intervention MBI scores than both Group A (adjusted mean difference = 21.15, 95% CI [12.49, 29.81], P < 0.001) and Group B (adjusted mean difference = 21.27, 95% CI [12.42, 30.12], P < 0.001). Exploratory neuroimaging analyses showed that only the change in ipsilesional sensorimotor cortex laterality index during motor imagery was significantly correlated with motor improvement (ρ = 0.404, P = 0.002, q = 0.012), whereas no resting-state or task-related fNIRS group comparisons remained significant after false discovery rate correction.Conclusions Synchronous BCI training was associated with superior clinical improvement compared with asynchronous and sham conditions in subacute stroke. The benefit was observed only when robotic assistance was contingent on real-time task performance, despite all three groups receiving comparable device exposure and motor imagery instruction. The neuroimaging results remain exploratory and should be confirmed in larger studies with prospectively defined imaging endpoints. Trial registration This trial was registered under the Chinese Clinical Trial Registry (ChiCTR2400091197) and was prospectively registered on October 21, 2024. Ethics Approval: Approved by the Ethics Committee of Xuzhou Rehabilitation Hospital (XK-LSW-20241017-009).
SN - 1743-0003
ER -