Reconnecting Minds to the World: Patient Perspectives on Brain-Computer Interface After High Cervical Spinal Cord Injury.

Abstract

Objective: To explore the perspectives of individuals with high cervical spinal cord injury (C-SCI) regarding expectations, concerns, and desired applications of brain-computer interface (BCI).

Methods: A structured focus group interview was conducted with four individuals with chronic high cervical spinal cord injury, all with neurological levels of C4 or above. Pre- and post-interview questionnaires were administered to assess expectations, concerns, and acceptance of BCI before and after discussion. The interview was facilitated by experts in rehabilitation medicine and biomedical engineering, and qualitative data were analyzed inductively to identify key themes.

Results: Five major themes emerged: digital accessibility, offline physical activity, social interactions and psychological health, usability, and acceptance. Participants expressed strong interest in using BCI to improve digital independence, particularly for messaging, online banking, internet use, and smart home control. They also viewed BCI as a potential tool to enhance autonomy in daily activities and reduce reliance on caregivers. Most participants were open to training and, in some cases, invasive procedures; however, concerns regarding surgical safety, device maintenance, reliability, and practical usability were frequently raised. Views on the emotional and social impact of BCI varied across individuals. Questionnaire responses showed increased willingness to undergo invasive procedures after the focus group interview, while expected functional outcomes became more realistic, suggesting that structured group discussion may have shaped participants' understanding of BCI.

Conclusion: BCI was perceived as a promising pathway to greater independence, participation, and autonomy among individuals with high C-SCI. These findings emphasize user-centered design and demonstrate how lived experience can guide assistive neurotechnology development in rehabilitation research.