Brain-controlled functional electrical stimulation restores bimanual object manipulation in chronic tetraplegia

Spinal cord injury causes paralysis, hindering daily activities, many of which require the coordinated use and interaction of both hands. Brain–computer interfaces (BCI) have previously enabled individuals with tetraplegia to regain voluntary movement, but applications were largely restricted to simple unimanual actions or sequential bimanual activation. Here, we present an intracranial neuroprosthesis combining chronic electrocorticography (ECoG) recordings from wireless 64-channel WIMAGINE implants with two surface functional electrical stimulators (sFES). This iBCI-sFES system enabled two participants to achieve real-time, concurrent bimanual asynchronous control of both hands, allowing simultaneous and independent movement to freely perform functional object manipulation in home-like environments. The neuroprosthesis features fast model calibration and is designed for stable long-term use, demonstrating feasibility for future deployment in real home settings. Moreover, we show that sFES enhances neural synchronization associated with motor intentions, promoting real-time afferent feedback to the sensorimotor cortex. Together, these results highlight the potential of iBCI-sFES not only to restore complex bimanual interactions in individuals with paralysis, but also to serve as a neurorehabilitation tool in long-term practice.