Brain-controlled neuromuscular stimulation to drive neural plasticity and functional recovery

•Brain-controlled functional electrical stimulation (FES) can restore motor function.•Appropriately timed neuromuscular electrical stimulation drives plastic changes.•Site, sign, and magnitude of changes depend on coordination with central activity.•Hence, brain-controlled FES may cause long-lasting recovery following stroke or SCI.

There is mounting evidence that appropriately timed neuromuscular stimulation can induce neural plasticity and generate functional recovery from motor disorders. This review addresses the idea that coordinating stimulation with a patient's voluntary effort might further enhance neurorehabilitation. Studies in cell cultures and behaving animals have delineated the rules underlying neural plasticity when single neurons are used as triggers. However, the rules governing more complex stimuli and larger networks are less well understood. We argue that functional recovery might be optimized if stimulation were modulated by a brain machine interface, to match the details of the patient's voluntary intent. The potential of this novel approach highlights the need for a better understanding of the complex rules underlying this form of plasticity.