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Neural Eng."],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    Conventional swallowing functional electrical stimulation (FES) is usually delivered in open loop or triggered by peripheral signals, which may not align precisely with voluntary swallowing intention. We developed a motor imagery-based brain\u2013computer interface (MI-BCI)-controlled closed-loop swallowing FES system for post-stroke dysphagia (PSD) and investigated its neurophysiological basis, decoding performance, and short-term feasibility.\n                    <jats:italic>Approach.<\/jats:italic>\n                    Two experiments were conducted. In experiment 1, swallowing MI (SMI)-related electroencephalography (EEG) features were identified in healthy controls (HC,\n                    <jats:italic>n<\/jats:italic>\n                    = 15), patients with PSD (\n                    <jats:italic>n<\/jats:italic>\n                    = 15), and post-stroke patients without dysphagia (PSND,\n                    <jats:italic>n<\/jats:italic>\n                    = 15). A threshold-based decoder based on Fp1 spectral power ratios was then validated in an independent HC cohort (\n                    <jats:italic>n<\/jats:italic>\n                    = 10). In experiment 2, 10 patients with PSD received 10 sessions of MI-BCI-controlled closed-loop swallowing FES over 2 weeks, and feasibility, usability, and safety were assessed.\n                    <jats:italic>Main results.<\/jats:italic>\n                    During SMI, Fp1 spectral power ratios decreased relative to rest. The\n                    <jats:italic>\u03b4\/\u03b1<\/jats:italic>\n                    ratio decreased significantly in all three groups, whereas the\n                    <jats:italic>\u03b4\/(\u03b1 + \u03b2)<\/jats:italic>\n                    ratio and the\n                    <jats:italic>(\u03b4 + \u03b8)\/(\u03b1 + \u03b2)<\/jats:italic>\n                    ratio decreased significantly in HC and PSND and showed the same downward trend in PSD. Patients with PSD also showed higher\n                    <jats:italic>\u03b8<\/jats:italic>\n                    -band power at T3 than HC and PSND (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.0382). The decoder achieved a mean classification accuracy of 71.5% in the independent validation cohort. In experiment 2, adherence was 100%, with 29.8 \u00b1 6.2 successful closed-loop triggers per session, a mean system usability scale score of 72.8 \u00b1 4.2, and no serious adverse events.\n                    <jats:italic>Significance.<\/jats:italic>\n                    These findings support the technical feasibility of the proposed system, indicate acceptable short-term usability, and show no major safety concerns during the intervention period.\n                    <jats:italic>Trial Registration.<\/jats:italic>\n                    ChiCTR2400079388.\n                  <\/jats:p>","DOI":"10.1088\/1741-2552\/ae730b","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T22:58:11Z","timestamp":1779836291000},"page":"036030","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and feasibility of a motor imagery-based brain\u2013computer interface-controlled closed-loop functional electrical stimulation system for swallowing rehabilitation"],"prefix":"10.1088","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7604-3992","authenticated-orcid":true,"given":"Cui","family":"Yu","sequence":"first","affiliation":[{"name":"Nanjing Medical University"},{"name":"Jiangsu Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9717-6151","authenticated-orcid":false,"given":"Xinchun","family":"Dong","sequence":"additional","affiliation":[{"name":"Jiangsu Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9731-9197","authenticated-orcid":false,"given":"Yuting","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital with Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7471-6911","authenticated-orcid":false,"given":"Xiaojiao","family":"Wan","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Engineering Research Center of Rehabilitation Medicine Brain-Computer Interface Technology and Equipment"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3256-0553","authenticated-orcid":false,"given":"Ya","family":"Zhou","sequence":"additional","affiliation":[{"name":"Yancheng NO. 1 People\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7688-9198","authenticated-orcid":false,"given":"Yongliang","family":"Zheng","sequence":"additional","affiliation":[{"name":"Jiangsu Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6729-2404","authenticated-orcid":false,"given":"Haiyan","family":"Liu","sequence":"additional","affiliation":[{"name":"Jinhu County People\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3467-4973","authenticated-orcid":false,"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Engineering Research Center of Rehabilitation Medicine Brain-Computer Interface Technology and Equipment"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1751-9597","authenticated-orcid":false,"given":"Zhengzhe","family":"Cui","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Engineering Research Center of Rehabilitation Medicine Brain-Computer Interface Technology and Equipment"},{"name":"Zhejiang University of Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8222-4391","authenticated-orcid":false,"given":"Chunli","family":"Wan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital with Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0658-4525","authenticated-orcid":false,"given":"Yongqiang","family":"Li","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital with Nanjing Medical University"},{"name":"Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"jneae730bbib1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","type":"journal-article","article-title":"World stroke organization: global stroke fact sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. 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