VIRTUAL REALITY–BASED BRAIN–COMPUTER INTERFACE FOR SPINAL CORD INJURY: CLINICAL AND NEUROPHYSIOLOGICAL EFFECTS

Brain–computer interfaces (BCIs) allow real-time device control using brain activity. Virtual reality (VR)-based BCIs have shown promise in improving sensorimotor function in spinal cord injury (SCI) rehabilitation, thought to originate from the reactivation of target neuronal pathways. However, the mechanisms underlying them are still unclear. Therefore, this study aims to characterize the effects of a VR-based BCI protocol in SCI. A chronic SCI participant (AIS A, T4) underwent 35 BCI sessions with trials involving rest or control of a virtual avatar using motor imagery, within an immersive VR environment with multimodal (audiovisual and tactile) feedback. Sensory and motor scores were assessed using the ISNCSCI, alongside pain intensity, possible adverse effects and user's sense of embodiment towards the avatar. Neural activity was recorded via electroencephalography (EEG). An ongoing study is evaluating the clinical effectiveness of this protocol in 20 SCI patients. In the pilot experiment, pain decreased, while self-reported quality of life increased, and alternating non-spastic lower limb movements appeared when engaged in motor imagery and under no stressful events. Neural spectral power analysis revealed changes across frequency bands, some correlating with pain variation, also revealing shifts in the delta/alpha band ratio. Data collection continues in the larger cohort, analyzing neurophysiological and molecular disease markers. Preliminary results suggest sustained VR-based BCI use in SCI patients may improve pain, quality of life, and motor function. Ongoing research aims to confirm these findings and support the implementation of BCI-based interventions in SCI rehabilitation programs.