Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6–12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI–FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways.

This work aims at corroborating the importance and efficacy of mutual learning in motor imagery (MI) brain–computer interface (BCI) by leveraging the insights obtained through our participation in the BCI race of the Cybathlon event. We hypothesized that, contrary to the popular trend of focusing mostly on the machine learning aspects of MI BCI training, a comprehensive mutual learning methodology that reinstates the three learning pillars (at the machine, subject, and application level) as equally significant could lead to a BCI–user symbiotic system able to succeed in real-world scenarios such as the Cybathlon event. Two severely impaired participants with chronic spinal cord injury (SCI), were trained following our mutual learning approach to control their avatar in a virtual BCI race game. The competition outcomes substantiate the effectiveness of this type of training. Most importantly, the present study is one among very few to provide multifaceted evidence on the efficacy of subject learning during BCI training. Learning correlates could be derived at all levels of the interface—application, BCI output, and electroencephalography (EEG) neuroimaging—with two end-users, sufficiently longitudinal evaluation, and, importantly, under real-world and even adverse conditions.

Objectives: Brain-computer interfaces (BCIs) are no longer only used by healthy participants under controlled conditions in laboratory environments, but also by patients and end-users, controlling applications in their homes or clinics, without the BCI experts around. But are the technology and the field mature enough for this? Especially the successful operation of applications -like text entry systems or assistive mobility devices such as tele-presence robots-requires a good level of BCI control. How much training is needed to achieve such a level? Is it possible to train naïve end-users in 10 days to successfully control such applications?Materials and methods: In this work, we report our experiences of training 24 motor-disabled participants at rehabilitation clinics or at the end-users' homes, without BCI experts present. We also share the lessons that we have learned through transferring BCI technologies from the lab to the user's home or clinics.Results: The most important outcome is that fifty percent of the participants achieved good BCI performance and could successfully control the applications (tele-presence robot and text-entry system). In the case of the * Corresponding author. tele-presence robot the participants achieved an average performance ratio of 0.87 (max. 0.97) and for the text entry application a mean of 0.93 (max. 1.0). The lessons learned and the gathered user feedback range from pure BCI problems (technical and handling), to common communication issues among the different people involved, and issues encountered while controlling the applications. Conclusion:The points raised in this paper are very widely applicable and we anticipate that they might be faced similarly by other groups, if they move on to bringing the BCI technology to the end-user, to home environments and towards application prototype control.