Robot-assisted brain-computer interface therapy for post-stroke rehabilitation: Preliminary effects on motor, cognitive, and functional outcomes

Stroke is a leading cause of long-term disability, and severe upper-limb paresis often persists despite conventional rehabilitation. Brain–computer interfaces (BCIs) have been proposed to support motor recovery by pairing motor imagery with contingent sensory feedback, although clinical evidence remains heterogeneous, particularly for robot-assisted systems. This pilot study evaluates the feasibility of a noninvasive motor-imagery (MI)-based BCI delivering simultaneous multimodal feedback (embodied visual avatar and robot-assisted hand movement), and characterizes motor, cognitive, and functional outcomes in stroke patients receiving it alongside conventional therapy. Sixteen individuals with first-ever stroke were allocated to a control group (CG, 𝑛 = 6 ) receiving conventional rehabilitation or an experimental group (EG, 𝑛 = 1 0 ) receiving the same therapy plus 23 one-hour BCI sessions. Motor, cognitive, and functional outcomes were assessed pre- and post-intervention and reported descriptively, consistent with guidance for pilot and feasibility trials. The EG showed pre-post point estimates whose 95% confidence intervals excluded zero across several motor (Fugl–Meyer Assessment total score: 25.0 to 33.6), cognitive (episodic memory, visuoconstructive performance), and functional (general health, functional independence) measures. The CG showed a similar pattern for some measures, including functional independence and physical and social health perceptions, indicating these gains were not exclusive to the EG; between-group effect sizes favored the EG over the CG for episodic memory and semantic verbal fluency. Usability was positively rated (mean 76.3/100; 95% CI: 64.8–87.7). These preliminary findings support the feasibility of the proposed therapy and motivate larger, adequately powered, ideally sham-controlled trials to confirm added clinical benefit over conventional rehabilitation.