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Purpose <p>This study aims to investigate whether the combination of transcranial Direct Current Stimulation (tDCS), Motor Imagery-based Brain-Computer Interface (MI-BCI), Neurofeedback (NF), and Functional Electrical Stimulation (FES) may induce post-stroke neuroplasticity.</p> Methods <p>A chronic post-stroke patient presenting with left hemiparesis underwent a 15-day MI-BCI-NF-FES training protocol designed to enhance upper limb motor recovery, consisting of 18-minute sessions that integrated visual and tactile feedback. Subsequently, the patient received 20&#xa0;min of tDCS followed by a continuation of the MI-BCI-NF-FES protocol for an additional 15 days, which was expected to potentially elicit neuroplasticity and improve motor recovery. Analyses included clinical assessments of recovery and EEG recordings of the cortical motor map. Statistical analyses included Kruskal-Wallis, Cohen’s d, and percentage change.</p> Results <p>Motor map reorganization and increased Mu/Beta band power Event- Related Desynchronization (ERD) were observed following MI-BCI-NF-FES, whereby contralesional activation correlated with clinical improvement, suggesting vicariation. The combination of tDCS further facilitated ipsilesional recruitment, enhancing ERD and functional recovery. Reported adverse effects included mental fatigue, evidenced by progressive Beta resynchronization, and tDCS-induced scalp erythema and dysesthesia.</p> Conclusion <p>Our observations suggest that MI-BCI-NF-FES facilitated motor recovery of the patient’s upper limb and promoted cerebral neuroplasticity, while tDCS may have contributed to the correction of maladaptive neuroplasticity and strengthened functional connectivity, thereby enhancing both BCI effectiveness and motor performance.</p>

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tDCS may enhance post-stroke neuroplasticity via real-time motor imagery BCI

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Fernando Bermudes Cabral,
  • Sheida Mehrpour,
  • Fernanda Vaz de Souza,
  • Jessica Paola Souza Lima,
  • Aura Ximena Gonzalez-Cely,
  • Teodiano Freire Bastos-Filho

摘要

Purpose

This study aims to investigate whether the combination of transcranial Direct Current Stimulation (tDCS), Motor Imagery-based Brain-Computer Interface (MI-BCI), Neurofeedback (NF), and Functional Electrical Stimulation (FES) may induce post-stroke neuroplasticity.

Methods

A chronic post-stroke patient presenting with left hemiparesis underwent a 15-day MI-BCI-NF-FES training protocol designed to enhance upper limb motor recovery, consisting of 18-minute sessions that integrated visual and tactile feedback. Subsequently, the patient received 20 min of tDCS followed by a continuation of the MI-BCI-NF-FES protocol for an additional 15 days, which was expected to potentially elicit neuroplasticity and improve motor recovery. Analyses included clinical assessments of recovery and EEG recordings of the cortical motor map. Statistical analyses included Kruskal-Wallis, Cohen’s d, and percentage change.

Results

Motor map reorganization and increased Mu/Beta band power Event- Related Desynchronization (ERD) were observed following MI-BCI-NF-FES, whereby contralesional activation correlated with clinical improvement, suggesting vicariation. The combination of tDCS further facilitated ipsilesional recruitment, enhancing ERD and functional recovery. Reported adverse effects included mental fatigue, evidenced by progressive Beta resynchronization, and tDCS-induced scalp erythema and dysesthesia.

Conclusion

Our observations suggest that MI-BCI-NF-FES facilitated motor recovery of the patient’s upper limb and promoted cerebral neuroplasticity, while tDCS may have contributed to the correction of maladaptive neuroplasticity and strengthened functional connectivity, thereby enhancing both BCI effectiveness and motor performance.