{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:27:16Z","timestamp":1793136436466,"version":"4.5.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:p>\n                    Brain\u2013computer interfaces (BCIs) are increasingly explored as tools for post-stroke neurorehabilitation. Motor imagery (MI)-based paradigms are widely used but may be difficult for some patients to perform reliably, motivating the exploration of alternative control strategies. This study presents a retrospective exploratory case series (\n                    <jats:italic>n<\/jats:italic>\n                    = 5) evaluating the feasibility and safety of a P300-based BCI paradigm designed to engage visuomotor transformation processes during upper limb rehabilitation. Two patients underwent rehabilitation using the P300-based paradigm, while three patients used an MI-based BCI within the same rehabilitation framework. In both conditions, BCI control was integrated with a robotic orthosis and an immersive virtual reality (VR) environment. BCI performance, neurophysiological responses (event-related potentials and event-related desynchronization), and clinical measures (Fugl\u2013Meyer Assessment of the Upper Extremity, NIHSS) were assessed before and after a 10-session rehabilitation course. All participants were able to achieve BCI control above chance level. Across cases, changes in clinical scores and consistent neurophysiological patterns associated with task engagement were observed. No adverse events or clinically significant safety concerns were identified. These findings suggest that a P300-based BCI paradigm incorporating visuomotor transformation can be feasibly implemented within a VR-assisted robotic rehabilitation framework. Given the exploratory design, small sample size, and heterogeneity of the cohort, the results should be interpreted as hypothesis-generating. Further controlled studies are required to determine the clinical relevance and potential applications of this approach.\n                  <\/jats:p>","DOI":"10.3389\/fnhum.2026.1774409","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:40:14Z","timestamp":1776145214000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: post-stroke rehabilitation with a visuomotor transformation-based brain-computer interface"],"prefix":"10.3389","volume":"20","author":[{"given":"Alisa","family":"Kokorina","sequence":"first","affiliation":[{"name":"Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolay","family":"Syrov","sequence":"additional","affiliation":[{"name":"Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lev","family":"Yakovlev","sequence":"additional","affiliation":[{"name":"Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail","family":"Lebedev","sequence":"additional","affiliation":[{"name":"Faculty of Mechanics and Mathematics, Lomonosov Moscow State University","place":["Moscow, Russia"]},{"name":"I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences","place":["Saint Petersburg, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5549","DOI":"10.1109\/IEMBS.2010.5626782","article-title":"Clinical study of neurorehabilitation in stroke using EEG-based motor imagery brain-computer interface with robotic feedback","volume":"2010","author":"Ang","year":"2010","journal-title":"Ann. Int. Conf. IEEE Eng. Med. Biol. Soc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1002\/ana.21827","article-title":"Developmental plasticity connects the visual cortex to motoneurons after stroke","volume":"67","author":"Basu","year":"2010","journal-title":"Ann. Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1007\/s11055-015-0183-8","article-title":"Changes in the N200 and P300 components of event-related potentials under variations of attention conditions in a brain-computer interface system","volume":"45","author":"Basyul","year":"2015","journal-title":"Neurosci. Behav. Physiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/0013-4694(92)90110-4","article-title":"Event-related desynchronization: effects of energetic and computational demands","volume":"82","author":"Boiten","year":"1992","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"B6","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1002\/acn3.544","article-title":"Brain-computer interfaces for post-stroke motor rehabilitation: a meta-analysis","volume":"5","author":"Cervera","year":"2018","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.rehab.2019.06.007","article-title":"Mu rhythm: state of the art with special focus on cerebral palsy","volume":"63","author":"D\u00e9mas","year":"2020","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"625983","DOI":"10.3389\/fnhum.2021.625983","article-title":"An online data visualization feedback protocol for motor imagery-based BCI training","volume":"15","author":"Duan","year":"2021","journal-title":"Front. Hum. Neurosci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3389\/fneng.2012.00014","article-title":"P300 brain-computer interface: current challenges and emerging trends","volume":"5","author":"Fazel-Rezai","year":"2012","journal-title":"Front. Neuroeng"},{"key":"B10","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1134\/S0362119714030062","article-title":"Localization of brain electrical activity sources and hemodynamic activity foci during motor imagery","volume":"40","author":"Frolov","year":"2014","journal-title":"Hum. Physiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"400","DOI":"10.3389\/fnins.2017.00400","article-title":"Post-stroke rehabilitation training with a motor-imagery-based brain-computer interface (BCI)-controlled hand exoskeleton: a randomized controlled multicenter trial","volume":"11","author":"Frolov","year":"2017","journal-title":"Front. Neurosci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. I. A method for the evaluation of physical performance","volume":"7","author":"Fugl-Meyer","year":"1975","journal-title":"Scand. J. Rehabil. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-017-0294-2","article-title":"Ipsilateral EEG mu rhythm reflects the excitability of uncrossed pathways projecting to the shoulder muscles","volume":"14","author":"Hasegawa","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"B14","doi-asserted-by":"publisher","first-page":"931","DOI":"10.3390\/brainsci15090931","article-title":"Neurodetector: EEG-based cognitive assessment using event-related potentials as a virtual switch","volume":"15","author":"Hasegawa","year":"2025","journal-title":"Brain Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1002\/hbm.20610","article-title":"Comparison of unilateral and bilateral complex finger tapping-related activation in premotor and primary motor cortex","volume":"30","author":"Horenstein","year":"2009","journal-title":"Hum. Brain Mapp."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1145\/3474662","article-title":"Who willed it? Decreasing frustration by manipulating perceived control through fabricated input for stroke rehabilitation BCI games","volume":"5","author":"Hougaard","year":"2021","journal-title":"Proc ACM Hum. Comput. Interact."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.1161\/STROKEAHA.112.665489","article-title":"Relationship between electrical brain responses to motor imagery and motor impairment in stroke","volume":"43","author":"Kaiser","year":"2012","journal-title":"Stroke"},{"key":"B18","doi-asserted-by":"publisher","first-page":"103843","DOI":"10.1016\/j.compbiomed.2020.103843","article-title":"Review on motor imagery-based BCI systems for upper limb post-stroke neurorehabilitation: from designing to application","volume":"123","author":"Khan","year":"2020","journal-title":"Comput. Biol. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"105705","DOI":"10.1016\/j.bandc.2021.105705","article-title":"Using motor imagery practice for improving motor performance: a review","volume":"150","author":"Ladda","year":"2021","journal-title":"Brain Cogn."},{"key":"B20","doi-asserted-by":"publisher","first-page":"CD008349","DOI":"10.1002\/14651858.CD008349.pub4","article-title":"Virtual reality for stroke rehabilitation","volume":"11","author":"Laver","year":"2017","journal-title":"Cochrane Database Syst. Rev"},{"key":"B21","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s40779-025-00598-z","article-title":"Recent applications of EEG-based brain-computer interface in the medical field","volume":"12","author":"Liu","year":"2025","journal-title":"Mil. Med. Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/01.npt.0000260567.24122.64","article-title":"The kinesthetic and visual imagery questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study","volume":"31","author":"Malouin","year":"2007","journal-title":"J. Neurol. Phys. Ther."},{"key":"B23","doi-asserted-by":"publisher","first-page":"41001","DOI":"10.1088\/1741-2552\/aba162","article-title":"BCI for stroke rehabilitation: motor and beyond","volume":"17","author":"Mane","year":"2020","journal-title":"J. Neural. Eng."},{"key":"B24","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1586\/17434440.2014.882766","article-title":"The value of robotic systems in stroke rehabilitation","volume":"11","author":"Masiero","year":"2014","journal-title":"Expert Rev. Med. Devices"},{"key":"B25","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/S0013-4694(97)00022-2","article-title":"Spatial filter selection for EEG-based communication","volume":"103","author":"McFarland","year":"1997","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.clinph.2010.10.029","article-title":"The P300-based brain-computer interface (BCI): effects of stimulus rate","volume":"122","author":"McFarland","year":"2011","journal-title":"Clin. Neurophysiol."},{"key":"B27","volume-title":"Aids to the Examination of the Peripheral Nervous System (Memorandum No. 45)","year":"1981"},{"key":"B28","doi-asserted-by":"publisher","first-page":"676","DOI":"10.23736\/S1973-9087.17.04591-9","article-title":"Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results","volume":"53","author":"Molteni","year":"2017","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment (MoCA): a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"B30","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S0079-6123(06)59014-4","article-title":"ERD\/ERS patterns reflecting sensorimotor activation and deactivation","volume":"159","author":"Neuper","year":"2006","journal-title":"Prog. Brain Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3389\/fneng.2014.00003","article-title":"Decoding repetitive finger movements with brain activity acquired via non-invasive electroencephalography","volume":"7","author":"Paek","year":"2014","journal-title":"Front. Neuroeng."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-016-0120-2","article-title":"EEG response varies with lesion location in patients with chronic stroke","volume":"13","author":"Park","year":"2016","journal-title":"J. Neuroeng. Rehabil."},{"key":"B33","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S0304-3940(97)00889-6","article-title":"Motor imagery activates primary sensorimotor area in humans","volume":"239","author":"Pfurtscheller","year":"1997","journal-title":"Neurosci. Lett."},{"key":"B34","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.brainresrev.2005.04.005","article-title":"The functional significance of mu rhythms: translating \u201cseeing\u201d and \u201chearing\u201d into \u201cdoing\u201d","volume":"50","author":"Pineda","year":"2005","journal-title":"Brain Res. Rev."},{"key":"B35","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.neuroscience.2016.11.023","article-title":"Neural plasticity during motor learning with motor imagery practice: review and perspectives","volume":"341","author":"Ruffino","year":"2017","journal-title":"Neuroscience"},{"key":"B36","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/0306-4522(94)90263-1","article-title":"Spatiotemporal characteristics of sensorimotor neuromagnetic rhythms related to thumb movement","volume":"60","author":"Salmelin","year":"1994","journal-title":"Neuroscience"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1126\/science.273.5281.1564","article-title":"The mental representation of hand movements after parietal cortex damage","volume":"273","author":"Sirigu","year":"1996","journal-title":"Science"},{"key":"B38","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.neulet.2010.10.072","article-title":"Event-related desynchronization of sensorimotor EEG rhythms in hemiparetic patients with acute stroke","volume":"488","author":"Stepie\u0144","year":"2011","journal-title":"Neurosci. Lett."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1180056","DOI":"10.3389\/fnhum.2023.1180056","article-title":"Beyond passive observation: feedback anticipation and observation activate the mirror system in virtual finger movement control via P300-BCI","volume":"17","author":"Syrov","year":"2023","journal-title":"Front. Hum. Neurosci."},{"key":"B40","doi-asserted-by":"publisher","first-page":"2607","DOI":"10.3390\/diagnostics12112607","article-title":"Mental strategies in a P300-BCI: visuomotor transformation is an option","volume":"12","author":"Syrov","year":"2022","journal-title":"Diagnostics"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e188","DOI":"10.1016\/j.rehab.2018.05.431","article-title":"Motor imagery-assisted brain-computer interface for gait retraining in chronic stroke neurorehabilitation","volume":"61","author":"Tang","year":"2018","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1161\/01.STR.19.5.604","article-title":"Interobserver agreement for the assessment of handicap in stroke patients","volume":"19","author":"van Swieten","year":"1988","journal-title":"Stroke"},{"key":"B43","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.neuropsychologia.2017.02.005","article-title":"Assessing motor imagery in brain-computer interface training: psychological and neurophysiological correlates","volume":"97","author":"Vasilyev","year":"2017","journal-title":"Neuropsychologia"},{"key":"B44","first-page":"302","article-title":"Lateralization of EEG patterns in humans during motor imagery of arm movements in a brain-computer interface","volume":"66","author":"Vasilyev","year":"2016","journal-title":"Zh. Vyssh. Nerv. Deiat. Im. I. P. Pavlova"},{"key":"B45","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1109\/TNSRE.2019.2903685","article-title":"BCI monitor enhances electroencephalographic and cerebral hemodynamic activations during motor training","volume":"27","author":"Wang","year":"2019","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B46","doi-asserted-by":"publisher","first-page":"ENEURO.0455-22.2023","DOI":"10.1523\/ENEURO.0455-22.2023","article-title":"Event-related desynchronization induced by tactile imagery: an EEG study","volume":"10","author":"Yakovlev","year":"2023","journal-title":"eNeuro"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2596","DOI":"10.1016\/j.neuroimage.2009.10.028","article-title":"Negative covariation between task-related \u03b1\/\u03b2 activity and BOLD in human sensorimotor cortex: an EEG-fMRI study","volume":"49","author":"Yuan","year":"2010","journal-title":"Neuroimage"},{"key":"B48","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1774409\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:40:15Z","timestamp":1776145215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1774409\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":48,"alternative-id":["10.3389\/fnhum.2026.1774409"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2026.1774409","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"article-number":"1774409"}}