Brain-computer Interface (BCI)-Guided Upper Limb Neurorehabilitation for Acute Stroke With the recoveriX System

Stroke is a leading cause of neurological disability and upper limb impairment. While conventional rehabilitation options exist, brain-computer interface (BCI)-based neurorehabilitation has emerged as a promising approach that records and decodes neural signals to drive rehabilitation devices or functional electrical stimulation. By re-coupling cortical motor intent to limb movement, BCI systems restore closed-loop neurofeedback and facilitate neuroplasticity through residual neural pathways. Motor intent is detected non-invasively via scalp electroencephalography (EEG), using characteristic changes in mu and beta rhythm activity known as event-related desynchronisation (ERD). This study aims to investigate how these electrophysiological signals change over time following stroke and their implications for BCI-based rehabilitation.

Inclusion Criteria: * Adults between age 21 to 80 years with hemorrhagic or ischemic stroke * Stroke onset within 2-12 weeks * Any demonstrated voluntary finger flexion or finger extension Oxford Medical Research Council (MRC) grade 0 to 4 (total 5) * Montreal Cognitive Assessment (MoCA) \> 20 * Ability to understand written and spoken instructions, as well as stable medical and neurological status. Exclusion Criteria: * Presence of previous diagnosis of stroke * Implanted pacemaker or continuous infusion pump * History of seizures or past history of epilepsy * Recent neurosurgery * Medical instability deemed by study team * Severe blindness * Anticipated life expectancy \4/10) or severe hemi anesthesia or spasticity in the paretic arm (modified Ashworth scale MAS \>2, total 4) * Fixed shoulder or finger joint contractures, active arthritis in any upper limb joint * Inability to tolerate upright supported sitting posture for at least 45 minutes * Disorders of consciousness or altered arousal states precluding active participation in the task. * Pregnant women will be excluded from the study as the safety of FES (electrical stimulations) on foetus is unclear.