Key Takeaways & Executive Findings
- •• MI-BCI training significantly improves upper limb motor function and daily living activities in stroke patients. • Intervention duration ≥4 weeks and frequency ≥20 sessions yield greater improvements in daily living ability and motor function. • MI-BCI enhances neuroplasticity and motor recovery by decoding motor imagery signals. • Current evidence is limited by methodological heterogeneity and small sample sizes, necessitating larger, rigorous RCTs.
Abstract
OBJECTIVE: To systematically evaluate the effects of motor imagery-based brain-computer training on upper limb motor function in patients with stroke, thereby providing evidence-based guidance for clinical practice. METHODS: The randomized controlled trials about the effects of motor imagery-based brain-computer interface training in patients with stroke were retrieved from databases (PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, VIP, and WanFang Data) from the establishment of the databases to July 2025. Two researchers independently conducted literature screening and data extraction. The Cochrane bias risk was used to evaluate the level of evidence. Rev Man 5.4 software was used for meta-analysis. RESULTS: Eleven studies encompassing 543 stroke survivors were ultimately included. The results of the meta-analysis showed that the experimental group had better outcomes than the control group in terms of the Fugl Meyer assess...
1. Introduction
Stroke is an acute cerebrovascular disease characterized by sudden rupture or blockage of cerebral blood vessels, leading to focal or global brain dysfunction. Approximately 70% of stroke patients experience varying degrees of functional impairment, primarily affecting motor, cognitive, speech, swallowing, urinary and bowel control, and psychological aspects, severely impacting daily living and quality of life. Upper limb motor dysfunction is particularly common, imposing a heavy burden on society. However, traditional rehabilitation interventions often yield suboptimal results, with limited recovery and constrained rehabilitation duration, highlighting the urgent need for cost-effective upper limb rehabilitation strategies.
Recent advances in neuroscience and engineering have propelled the development of brain-computer interface (BCI) technology, which has garnered attention as a cutting-edge rehabilitation modality. BCI enables information exchange and control by connecting the brain to external devices, with invasive and non-invasive variants. In stroke rehabilitation, non-invasive approaches, including motor imagery-based BCI (MI-BCI), functional electrical stimulation-based BCI (BCI-FES), and steady-state visually evoked potentials (SSVEP), are predominantly applied. MI-BCI decodes motor imagery-related neural activity to activate motor neural circuits without actual limb movement, promoting motor function reconstruction. By decoding brain signals, BCI modulates sensorimotor rhythms generated by sensorimotor cortical neurons to control external devices, while motor imagery activates cortical motor areas, enhancing neuroplasticity. The combination of these approaches not only augments the effects of motor imagery but also provides real-time feedback to improve the specificity of rehabilitation training, making it a promising method for promoting upper limb recovery after stroke.
In the international research arena, MI-BCI has achieved continuous progress in stroke rehabilitation. Preliminary studies indicate that using the Promotoer BCI system, which meets rehabilitation requirements, for motor imagery training effectively promotes upper limb motor recovery. Recent research found that the RehabSwift system developed with the University of Adelaide can translate imagined hand movements into actual actions; after 18 training sessions, hand motor function significantly improved in 12 chronic stroke patients, and this improvement was sustained.
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Guan Hui, Hou Wangjun, Fang Enhui, Chen Kang, Zhuang He (2026). Motor imagery-based brain-computer interface rehabilitation training improves upper limb motor function in stroke patients: a meta-analysis. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21605
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Frequently Asked Questions
What is motor imagery-based brain-computer interface (MI-BCI) training?
MI-BCI training is a non-invasive rehabilitation technique that decodes brain signals generated during motor imagery to control external devices, thereby promoting neuroplasticity and motor recovery in stroke patients.
How effective is MI-BCI training for upper limb recovery in stroke patients?
This meta-analysis found that MI-BCI training significantly improves upper limb motor function and daily living activities, as evidenced by improvements in Fugl-Meyer Assessment, Wolf Motor Function Test, and Modified Barthel Index scores.
What are the optimal parameters for MI-BCI training?
Subgroup analysis suggests that intervention durations of at least 4 weeks and frequencies of at least 20 sessions yield greater improvements in daily living ability and motor function.
Are there any limitations to the current evidence?
Yes, the included studies had methodological heterogeneity and small sample sizes, which may affect the reliability of the conclusions. Larger, rigorously designed randomized controlled trials are needed.
What are the implications for clinical practice?
MI-BCI training appears to be a promising adjunct to conventional rehabilitation for improving upper limb function in stroke patients, but clinicians should consider individual patient factors and the need for further evidence.
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