The application of brain–computer interfaces in spinal cord injury rehabilitation: Progress and prospects

Brain-spine interface: an exploration of a potential future treatment for spinal cord injury

Spinal cord injuries (SCIs) profoundly impact millions globally, leading to loss of motor and sensory functions below the injury site. Brain-spine interfaces (BSIs) represent an early-stage neuroprosthetic strategy that attempts to restore functional communication between cortical motor-intention signals and spinal sensorimotor circuits below the level of injury. Although early preclinical and highly selected clinical studies have shown encouraging motor outcomes, the evidence remains preliminary, and routine clinical use is limited by questions regarding safety, durability, patient selection, accessibility, and long-term functional benefit. BSI approaches are based on the observation that residual spinal pathways and sensorimotor circuits may remain partially responsive to neuromodulation even after injury. Along the way, technological advancements have significantly bolstered SCI treatment strategies, ranging from surgical interventions to regenerative therapies. Approaches such as neurostimulation and biomaterial-based strategies have shown potential in experimental and early translational settings, although their clinical efficacy and generalizability remain incompletely established. Furthermore, exploring neuroplasticity and the body’s intrinsic ability to reorganize neural connections post-injury underscores the potential for spontaneous recovery in certain cases. However, integrating BSIs into clinical practice faces substantial hurdles, including technical challenges, ethical considerations, and the need for specialized training for healthcare providers. Despite these obstacles, BSIs and other novel treatments may have potential to improve the quality of life for SCI patients, although further clinical investigation is needed to establish their safety, efficacy, and generalizability. This review catalogs recent conceptual and technological developments contributing to the emergence of BSI.

A Review of Brain-Computer Interfaces in Neurorehabilitation and Nursing Care for Patients with Paraplegia

This review systematically summarizes the definition, principles, classification, and clinical value of non -invasive EEG‑BCI and invasive implantable BCI and constructs a comprehensive nursing model that includes pre-rehabilitation assessment, intra-training monitoring, complication prevention, psychological intervention, and home -based continuing care.

[Emerging role of brain-computer interface in orthopedic rehabilitation and motor function restoration].

BRAIN–SPINE INTERFACES AFTER CERVICAL SPINAL CORD INJURY: BIDIRECTIONAL NEURAL BYPASSES, EPIDURAL STIMULATION, AND SENSORIMOTOR RESTORATION

AbstractBackground. Cervical  spinal  cord  injury  disrupts  descending  motor  commands,  sensory information,  and  autonomic  regulation,  producing  tetraplegia  incompletely  reversible  with rehabilitation. Brain–spine interfaces seek to re-establish communication across the lesion by decoding cortical intention and delivering patterned spinal stimulation, while bidirectional systems restore somatosensory feedback.Materials and methods. A structured narrative review integrated trials, prospective cohorts, first-in-human studies, neurophysiological investigations, regulatory documents, and reports published through July 2026. Evidence was organized by biological plausibility, neural-signal acquisition, decoding  performance,  spinal-target  selectivity,  sensorimotor  integration,  safety,  durability, rehabilitation dependence, and translational readiness. A prospective multicenter comparative protocol was developed for adults with chronic cervical injury and neurological stability.Results. The  synthesis  addresses  cortical  decoding,  epidural  and  transcutaneous  spinal neuromodulation,  upper-limb  and  locomotor  restoration,  artificial  sensory  feedback,  autonomic effects, and activity-dependent neuroplasticity. Implanted brain–spine systems have enabled intention- driven standing and walking in an individual with chronic tetraplegia, whereas non-invasive cervical stimulation combined with task practice has improved hand strength and sensation in cohorts. A double neural bypass reported in 2026 integrated intracortical decoding, patterned spinal stimulation, and cortical sensory stimulation, producing immediate assistance together with persistent motor and sensory gains in one participant. The proposed primary endpoint is functional independence measured by  SCIM  III  and  task-specific  upper-extremity  performance  without  device-related  morbidity. Secondary endpoints include GRASSP, CUE-T, gait capacity, decoding latency, sensory localization, autonomic stability, quality of life, caregiver burden, durability, and cost-effectiveness.Conclusion. Brain–spine  interfaces  are  evolving  from  proof-of-concept  bypasses  toward restorative  neuroprosthetic  systems.  Multicenter  validation,  standardized  endpoints,  transparent algorithms, and long-term surveillance remain essential.Keywords: cervical spinal cord injury, tetraplegia, brain–spine interface, brain–computer interface,  epidural  spinal  cord  stimulation,  transcutaneous  stimulation,  neural  bypass,  sensory feedback, neuroplasticity.

Emerging brain computer interface-based approaches in stroke rehabilitation: A review of current evidence and comparison with conventional physiotherapy

Background: Stroke is one of the leading causes of long-term disability worldwide and is increasingly being reported among young adults, resulting in substantial physical, psychological, and socioeconomic challenges. Although conventional physiotherapy plays a central role in stroke rehabilitation, many individuals with severe motor deficits do not achieve complete functional recovery. In recent years, Brain–Computer Interface (BCI) technology has emerged as a promising adjunct to rehabilitation by directly interpreting brain activity to facilitate movement, promote neuroplasticity, and enhance motor recovery through external assistive devices. Objective: To review the current evidences on the role of Brain-Computer Interface (BCI) approaches and comparison with conventional physiotherapy in stroke rehabilitation. Methods: A literature review was performed by searching electronic databases, including PubMed, Google Scholar, ScienceDirect, ProQuest, and Mendeley, for studies published between 2015 and 2025. The search was carried out using keywords related to Brain–Computer Interface (BCI), EEG-based BCI, stroke rehabilitation, neuroplasticity, and neurorehabilitation. Studies were screened according to predefined inclusion and exclusion criteria, and 10 relevant articles comprising systematic reviews, meta-analyses, randomized controlled trials, review articles, and case studies were included for critical appraisal and evidence synthesis. Results: The Reviewed studies consistently showed that non-invasive EEG-based Brain–Computer Interface (BCI), when used alongside conventional physiotherapy and other rehabilitation approaches such as functional electrical stimulation, robotic-assisted therapy, and virtual reality, was associated with improved upper-limb motor function, motor control, functional independence, and neuroplasticity in individuals with stroke. Several studies also reported that BCI enhanced communication abilities in patients with severe paralysis and locked-in syndrome. While invasive BCI systems offered greater signal accuracy, non-invasive EEG-based BCIs were considered safer, more practical, and better suited for routine clinical rehabilitation. Conclusion: Based on the reviewed evidences, Brain–Computer Interface (BCI) shows promise as an adjunct to conventional physiotherapy for improving stroke rehabilitation outcomes. Further high-quality studies are needed to establish standardized protocols and confirm its long-term clinical effectiveness.

Bioengineered Interfaces for Peripheral Nerve Sensory Restoration.

Peripheral nerve injuries (PNIs) severely impair motor and sensory function, diminishing patient independence and quality of life. Despite decades of research, rehabilitation has prioritized motor recovery and residual function over the sensory restoration essential for embodiment, intuitive control, and natural movement. This lack of feedback drives poor prosthetic integration, high cognitive demand, and high abandonment rates. This review organizes the field along the translational pathway from injury to functional recovery: the biology of what is lost, strategies that restore the native substrate, the interfaces required when it cannot be rebuilt, and how these strategies are integrated and embodied. Approaches are compared by biological target, sensory function restored, invasiveness, clinical maturity, and limitation, emphasizing how interface properties such as modulus mismatch, charge injection capacity, and foreign body response govern long-term stability and naturalness. Proprioception, the hardest and least measurable sensation to restore, is examined in depth, as are biomimetic, neuromorphic, biohybrid, and machine-learning approaches toward adaptive, closed-loop communication, weighed against their limits to adoption. The review closes with design principles and the challenges they face, from power and scalability to regulatory and ethical hurdles. The future lies in patient-centered interfaces that let individuals not only move, but feel again.