Brain–computer interfaces for stroke rehabilitation in Africa: Evidence gaps, barriers, and implementation opportunities

Stroke is a leading cause of disability in Africa, where post-stroke rehabilitation remains significantly underdeveloped. Brain–computer interfaces (BCIs) have emerged as promising tools for enhancing neuroplasticity and functional recovery by decoding cortical signals and coupling them with rehabilitative feedback. Despite a growing global evidence base, no published BCI-based stroke rehabilitation trials, implementation studies, or clinical programs have been reported from the African continent. This narrative review synthesizes the global evidence on BCI-assisted post-stroke rehabilitation, documents the Africa-specific evidence gap through a structured literature search, characterizes the structural barriers to BCI implementation in low-resource African settings, and proposes a pragmatic, equity-centered framework to guide future research and implementation. Randomized controlled trials and meta-analyses have demonstrated that electroencephalography (EEG)-based BCIs can improve motor, gait, cognitive, and communication rehabilitation outcomes through closed-loop sensorimotor recoupling and Hebbian plasticity. A structured literature search identified no published BCI-based stroke rehabilitation trials, feasibility studies, or implementation programs in Africa, despite the continent having one of the highest global burdens of stroke-related disability. The major barriers include high equipment costs, unreliable power infrastructure, limited neurorehabilitation workforce capacity, culturally unvalidated motor imagery paradigms, and the absence of African EEG datasets for classifier development and validation. Emerging opportunities include low-cost open-source EEG platforms, task-shifting models, mobile signal processing, and an expanding African neuroscience research infrastructure. Addressing this gap will require coordinated investment in context-appropriate technologies, African-led, North-supported research partnerships, African neurophysiological data generation, and locally led clinical trials to ensure that future advances in neurorehabilitation are both scientifically rigorous and globally equitable.