Introduction: In Hong Kong, advanced neuro-rehabilitation technologies such as Brain-Computer Interfaces (BCI) remain an emerging practice. For survivors of chronic stroke, conventional therapy often reaches a plateau in motor recovery. This case study evaluates the clinical impact of a multi-modal closed-loop BCI system—integrating Electroencephalography (EEG), Functional Electrical Stimulation (FES), Motor Imagery (MI), and Virtual Reality (VR)—on a patient one year post-stroke.
Methods: A 65-year-old female, one year post-left cerebrovascular accident (CVA), presented with severe upper limb impairment. Baseline measures showed a Functional Test for the Hemiparetic Upper Extremity (FTHUE) Level 1 and a Box and Block Test (BBT) score of 0. The intervention involved 25 sessions. The system detected MI intentions via EEG to trigger synchronized FES and VR feedback, creating a closed-loop neurofeedback environment designed to facilitate neuroplasticity.
Results: Following the 25-session protocol, the patient demonstrated significant functional gains despite being in the chronic phase. FTHUE improved from Level 1 to Level 3, and BBT scores rose from 0 to 10 blocks. Active Range of Motion (AROM) showed marked increases: shoulder flexion from 0° to 110°, elbow flexion/extension from 0° to 100°, and wrist extension from 0° to 10°. No adverse effects were noted, and the patient reported high motivation throughout the VR-enhanced training.
Conclusion: These results suggest that BCI-FES-VR training can effectively drive motor recovery in chronic stroke. This case supports the feasibility of implementing closed-loop BCI technology within Hong Kong’s clinical landscape to improve functional outcomes for long-term stroke survivors.