Functional electrical stimulation therapy (FEST) is one of the few interventions that can engage paralyzed muscles in task-oriented exercises, regardless of impairment level. The recent adoption of brain-computer interfacing (BCI) in neurorehabilitation has brought about a novel FEST approach:​ BCI-controlled FEST or BCI-FEST. In this new intervention, the BCI monitors the patient’s brain activity during therapy, and it triggers the stimulation when it detects an imagined or attempted movement.

A single-channel BCI for clinical application was designed, developed, and integrated with FEST for arm and hand rehabilitation. In the first study of this work, the feasibility of having a therapist and a BCI operator deliver BCI-FEST to an individual with chronic stroke was evaluated. The BCI-FEST was safe and feasible, with no adverse events recorded in 80 hours of therapy. Most importantly, the intervention resulted in the participant experiencing meaningful improvements even after other conventional rehabilitation strategies had previously failed to produce a change. Based on the participant’s experience using the BCI in the stroke case study and the therapists’ feedback, the system was upgraded into a new version named KITE-BCI. Motivated by the preliminary results in stroke, BCI-FEST was evaluated in individuals with spinal cord injury (SCI). An interventional study was conducted to assess the feasibility of delivering BCI-FEST in a clinical environment and to understand the potential clinical efficacy of BCI-FEST upper limb motor rehabilitation in five individuals with subacute SCI. The new BCI-FEST was safe and feasible and with a setup time of 11 minutes, comparable to other technology-enhanced interventions. The average success rate of KITE-BCI in triggering the stimulation surpassed the 70% threshold for a reliable BCI system. In terms of clinical efficacy, three out of five participants demonstrated increased scores in self-reported assessments of independence. Furthermore, all participants demonstrated increased scores in observational assessments of motor function.

In conclusion, the work presented here validates BCI-FEST as a safe, feasible, and clinically viable rehabilitation strategy and, more importantly, with promising clinical efficacy for improving voluntary arm and hand motor function following a stroke or SCI.