Adaptive Neural Reorganization Enables Real-Time Finger-Level Robotic Control in BCI-Naïve Stroke Survivors.

Restoring hand function remains a major challenge for individuals with motor impairments following stroke. Noninvasive brain-computer interfaces (BCIs) aim to address this problem by translating neural signals into robotic assistance; however, control of individual fingers has not been demonstrated in BCI-naïve populations. In this study, we investigated whether individuals with stroke and no prior BCI experience could achieve finger-level robotic control using motor imagery. Nine stroke-affected participants performed real-time BCI tasks to control a robotic hand through imagined finger movements decoded from electroencephalography. On average, participants achieved decoding accuracies of 84% for two-finger tasks and 61% for three-finger tasks, demonstrating reliable control at the level of individual fingers. These results indicate that discriminable neural signals for fine motor control persist after stroke and can be leveraged using data-driven deep learning decoders. Sensor-level and source-level electrophysiological analyses further reveal patterns of stroke-related neural reorganization. Overall, these findings support the potential of noninvasive, finger-level BCIs for post-stroke robotic assistance.