Cortical modulation through robotic gait training with motor imagery brain-computer interface enhances bladder function in individuals with spinal cord injury

Neurogenic bladder (NB) dysfunction in individuals with complete spinal cord injury (SCI) is a condition that significantly affects quality of life. Despite the prevalence of interventions, there is a substantial gap in effective treatments for this dysfunction. This study proposes robotic-assisted gait training combined with motor imagery (MI)-based brain-computer interface (BCI) to induce improved cortical modulation, and consequently improve bladder function in patients with SCI. The study involved seven men with complete and chronic SCI in a protocol comprising 24 sessions of robotic-assisted walking with BCI and MI. This regimen was designed to teach both mu (µ, 8-12 Hz) and beta (β, 15-20 Hz) modulation through MI practices using multi-channel EEG neurofeedback (NFB), focusing on sensorimotor rhythm (SMR) activation. Clinical outcomes were measured using the neurogenic bladder symptom score (NBSS), which revealed substantial improvements in bladder control among participants. EEG analysis confirmed a significant correlation between modulation of µ and β rhythms with decreased NBSS scores. Our findings support that robotic-assisted gait training combined with MI-based BCI effectively modulates with more precision the cortical µ and β rhythms and improves NB dysfunction in SCI individuals.