# Toward Brain-Computer Interface motor rehabilitation for people with Multiple Sclerosis

## TL;DR

A brain-computer interface combined with electrical stimulation and virtual reality improved walking and mobility in people with Multiple Sclerosis, with benefits lasting up to six months.

## Contribution

This study introduces a novel BCI-based rehabilitation system for MS patients that shows sustained clinical improvements in gait and mobility.

## Key findings

- Walking endurance improved by 37.3 meters after treatment and remained stable for six months.
- Mobility and speed improved significantly, with benefits lasting after six months.
- Patient-reported outcomes and spasticity also showed statistically and clinically meaningful improvements.

## Abstract

Multiple Sclerosis (MS) is a chronic neurodegenerative disease in which the immune system attacks the myelin sheaths around nerves. People with MS (pwMS) often experience pain, fatigue, cognitive dysfunction, and reduced mobility. Today, MS is incurable, and treatments can at best slow the progression of the disease and manage symptoms. We conducted a preliminary, single-arm study using a motor-imagery brain–computer interface (MI-BCI) with functional electrical stimulation (FES) and virtual reality avatar targeting gait in pwMS.

Twenty-six pwMS were enrolled; 24 completed 30 BCI sessions. Outcomes were assessed at Baseline, immediately post-treatment (Post1, week 13) and during follow-up (Post2, week 17; Post3, week 37). Change from baseline was analyzed using mixed models for repeated measures (with log-ratio models for skewed measures) and multiplicity control. This uncontrolled study is hypothesis-generating.

Patients treated with the BCI-based intervention obtained significant improvements that were largely maintained to 6 months after the therapy. The walking endurance, assessed by the 6-minute walking test (6MWT), increased by 37.3 m (95% CI 21.50–53.10) after the treatment (p < 0.001), exceeding the minimal clinically important difference (MCID). This improvement in the walking endurance was maintained during the following 6 months after the intervention. Mobility/speed improved: TUG and T25FW times decreased by −15.5% and −16.4% after the last BCI session (both p < 0.001), with benefits persisting after 6 months. Spasticity (MAS) declined by about 1 point, and patient-reported outcomes improved statistically and clinically (MSIS-29 10.18 points, MFIS 7.29 points). Pairwise post-visit contrasts were not significant, consistent with maintenance. Exploratory models found no consistent MS-subtype effect on 6MWT change and suggested larger gains with higher baseline EDSS. Two discontinuations were due to participant availability, not concerns with fatigue or safety.

In this preliminary, single-arm study, a MI-BCI + FES system was associated with statistically significant, clinically meaningful gains in gait endurance, mobility/speed, spasticity, and patient-reported outcomes, sustained up to 6 months after the intervention.