Safety and Efficacy of Early Brain-Computer Interface Training After Reperfusion Therapy in Acute Ischemic Stroke (RT-BCI)

This is a multicenter, prospective, randomized controlled trial designed to evaluate the efficacy, safety, and feasibility of early EEG-based non-invasive brain-computer interface (EEG-BCI) training as an add-on to standard early rehabilitation in patients with acute ischemic stroke (AIS) after reperfusion therapy. Eligible participants are adults aged 18 to 80 years with unilateral limb motor dysfunction after intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Participants will be randomized to receive either standard early rehabilitation plus closed-loop EEG-BCI dual-module virtual hand and gait training, or standard early rehabilitation alone.

The EEG-BCI intervention includes upper-limb virtual hand training and lower-limb gait/ankle dorsiflexion training, delivered twice daily for approximately 20 minutes per session over 5 consecutive days. The primary outcome is the change in Fugl-Meyer Assessment for Upper Extremity (FMA-UE) score from baseline (T0) to Day 30. Secondary outcomes include upper- and lower-limb motor function, ambulation, neurological status, disability, and activities of daily living. Safety and feasibility outcomes will also be assessed.

Study Overview

• Status: Not yet recruiting
• Conditions: Acute Ischemic Stroke
• Intervention / Treatment: Device: EEG-based non-invasive brain-computer interface (BCI) virtual hand/gait training system; Behavioral: Standard Early Rehabilitation

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Wang Chen, MD; Phone Number: +86-68773274; Email: chenwang@sph.com.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 1. Age 18 to 80 years.
• 2. Acute ischemic stroke (AIS) treated with reperfusion therapy, including intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT); for participants undergoing MT, successful recanalization during the procedure defined as eTICI 2b-3.
• 3. Meets the protocol-defined clinical stability criteria for the corresponding treatment pathway (see Section 4.3).
• 4. Unilateral limb motor dysfunction on the same side as the dominant hand.
• 5. Fugl-Meyer Assessment for Upper Extremity (FMA-UE) score of 10 to 50 at T0.
• 6. Pre-stroke modified Rankin Scale (mRS) score <= 2.
• 7. Written informed consent provided by the participant and ability to comply with training and follow-up; if necessary, consent may be provided by a legally authorized representative.

Exclusion Criteria:

• 1. Imaging-confirmed symptomatic intracranial hemorrhage (sICH), or bleeding risk considered unacceptable by the investigator and requiring a change in treatment strategy.
• 2. Overt progressive neurological deterioration or need for urgent intervention, making training inappropriate, such as an increase in National Institutes of Health Stroke Scale (NIHSS) score of >=4 from a prior assessment with cause not yet clarified or stabilized.
• 3. Severe disturbance of consciousness, severe aphasia or neglect, or significant cognitive impairment that would prevent completion of BCI training tasks or primary outcome assessment.
• 4. Bilateral significant motor impairment, such as brainstem or bilateral lesions, or pre-existing moderate-to-severe disability of the contralateral upper or lower limb, which would interfere with training or interpretation of assessments under the unilateral impairment framework.
• 5. Severe comorbidity or unstable vital signs, including but not limited to unstable arrhythmia, severe heart failure or respiratory failure, active severe infection or sepsis, or severe hepatic or renal failure, such that the investigator judges the participant unable to safely complete training and follow-up.
• 6. Severe scalp skin damage or infection, or any other condition preventing safe use of the EEG electrode cap.
• 7. Frequent seizures within 7 days before randomization, or seizure risk considered unacceptable by the investigator.
• 8. Pregnancy or breastfeeding.
• 9. Participation in another interventional clinical study that may affect the outcomes of this study, or any other condition that, in the investigator's judgment, makes the participant unsuitable for enrollment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental BCI Rehabilitation Group; Standard early rehabilitation plus early EEG-BCI dual-module virtual hand and gait training	Device: EEG-based non-invasive brain-computer interface (BCI) virtual hand/gait training system; Closed-loop EEG-based non-invasive brain-computer interface training added to standard early rehabilitation, including virtual hand training for the upper limb and gait/ankle dorsiflexion training for the lower limb. Training is delivered twice daily, approximately 20 minutes per session, for 5 consecutive days.; Behavioral: Standard Early Rehabilitation; Participants receive site-standard early rehabilitation according to the local rehabilitation protocol.
Active Comparator: Standard Early Rehabilitation Group; Standard early rehabilitation without additional BCI training.	Behavioral: Standard Early Rehabilitation; Participants receive site-standard early rehabilitation according to the local rehabilitation protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Fugl-Meyer Assessment for Upper Extremity (FMA-UE) score	Change is calculated as the Day 30 FMA-UE score minus the baseline (T0) FMA-UE score. Higher positive values indicate greater improvement in upper-extremity motor function. T0 is defined as 48 hours after IVT for the IVT-only pathway, and Day 5 (120 ± 24 hours) after MT for the MT ± IVT pathway.	Baseline (T0), Day 30

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fugl-Meyer Assessment for Upper Extremity (FMA-UE) score	Upper-extremity motor impairment assessed using the Fugl-Meyer Assessment for Upper Extremity. Higher scores indicate better upper-extremity motor function.	Day 10 (±2 days), Day 30, Day 90
Action Research Arm Test (ARAT) score	Upper-limb activity limitation assessed using the Action Research Arm Test. Higher scores indicate better upper-limb function.	Day 10 (±2 days), Day 30, Day 90
Fugl-Meyer Assessment for Lower Extremity (FMA-LE) score	Lower-extremity motor impairment assessed using the Fugl-Meyer Assessment for Lower Extremity. Higher scores indicate better lower-extremity motor function.	Day 10 (±2 days), Day 30, Day 90
Functional Ambulation Category (FAC) score	Walking ability assessed using the Functional Ambulation Category. Higher scores indicate greater independence in ambulation.	Day 10 (±2 days), Day 30, Day 90
10-Meter Walk Test (10MWT) performance	Walking performance assessed by the 10-Meter Walk Test in participants who meet prespecified walking criteria. Walking speed and/or time required to complete the test will be recorded.	Day 10 (±2 days), Day 30, Day 90
Timed Up and Go (TUG) test performance	Functional mobility assessed by the Timed Up and Go test in participants who meet prespecified walking criteria. Time required to complete the test will be recorded.	Day 10 (±2 days), Day 30, Day 90
National Institutes of Health Stroke Scale (NIHSS) score	Neurological deficit severity assessed using the National Institutes of Health Stroke Scale. Lower scores indicate less severe neurological impairment.	Day 10 (±2 days), Day 30, Day 90
Modified Rankin Scale (mRS) score	Global disability assessed using the modified Rankin Scale. Lower scores indicate less disability and greater functional independence.	Day 30, Day 90
Barthel Index (BI) / Modified Barthel Index (MBI) score	Activities of daily living assessed using the Barthel Index or Modified Barthel Index, according to the scale used at each study site. Higher scores indicate better functional independence in daily activities.	Day 10 (±2 days), Day 30, Day 90

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Screening-to-enrollment ratio	Feasibility outcome defined as the number of participants enrolled and randomized divided by the total number of participants screened.	Through completion of recruitment, an estimated 16 months
Intervention adherence rate	Feasibility outcome defined as the proportion of planned training sessions completed by each participant.	During the 5-day intervention period
Effective BCI training duration	Feasibility outcome defined as the cumulative duration of valid BCI training completed during the intervention period.	During the 5-day intervention period
EEG signal quality and classification accuracy	Feasibility outcome assessing the quality of EEG acquisition and the performance of signal classification during BCI training sessions.	During the 5-day intervention period
Follow-up completion rate	Feasibility outcome defined as the proportion of randomized participants who complete scheduled outcome assessments through Day 90.	Through Day 90
Protocol deviation rate	Feasibility outcome defined as the proportion of participants with one or more protocol deviations.	From randomization through Day 90
Incidence of symptomatic intracranial hemorrhage	Safety outcome defined as the occurrence of symptomatic intracranial hemorrhage after study enrollment.	From T0 through Day 30
Incidence of any intracranial hemorrhage	Safety outcome defined as the occurrence of any type of intracranial hemorrhage after study enrollment.	From T0 through Day 30
Incidence of neurological deterioration	Safety outcome defined as clinical neurological worsening after study enrollment according to the study protocol.	From T0 through Day 30
Incidence of seizures	Safety outcome defined as the occurrence of seizure events after study enrollment.	From T0 through Day 30
Incidence of falls	Safety outcome defined as the occurrence of falls during the study period.	From T0 through Day 30
Incidence of blood pressure or cardiac rhythm adverse events	Safety outcome defined as blood pressure instability or cardiac arrhythmia events occurring during the study period.	From T0 through Day 30
Incidence of puncture-site bleeding or hematoma	Safety outcome assessed in participants in the MT pathway, defined as puncture-site bleeding or hematoma after mechanical thrombectomy.	From T0 through Day 30
Incidence of training-related discomfort	Safety outcome defined as training-related discomfort, including fatigue, headache, skin irritation, or other reported discomfort associated with the intervention.	During the 5-day intervention period

Collaborators and Investigators

• Sponsor: Shandong Provincial Hospital
• Investigators: Principal Investigator: QinJian Sun, MD, Shandong Provincial Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: April 29, 2026
• First Submitted That Met QC Criteria: May 8, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Ischemic Stroke
• Other Study ID Numbers: RT-BCI-2026-0219

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The IPD will be available from Principal Investigators (Prof. Qinjian Sun) upon reasonable request 6 months after the trial completion.
• IPD Sharing Time Frame: IPD will be made available 6 months after the completion of the trial.
• IPD Sharing Access Criteria: The IPD can be accessed by Principal Investigators (Prof. Qinjian Sun) 6 months after the completion of the trial, subject to a reasonable request.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No