Perception of brain-computer interface implantation surgery for motor, sensory, and autonomic restoration in spinal cord injury and stroke

Introduction: Stroke and spinal cord injury (SCI) can profoundly diminish quality of life across physical and psychosocial domains, with motor and sensory deficits often persisting despite current therapies. Invasive brain-computer interface (BCI) systems, particularly electrocorticography (ECoG)-based approaches, offer a potential means to bypass neural injury and restore function. To inform development and deployment, it is critical to understand candidate users' willingness to adopt such technology and how that willingness relates to their functional goals and rehabilitation priorities. Methods: We conducted a survey assessing receptiveness to surgical implantation of ECoG grids for BCI use and eliciting participants' rehabilitative goals and perceived priorities across motor and sensory domains. We examined associations between willingness to undergo implantation and (1) the level of functional recovery hypothetically offered, (2) stated rehabilitative priorities, and (3) self-reported disability. Results: = 1). Across this cohort, respondents reported a high willingness to undergo surgery for ECoG-based BCI if it could restore basic functions, including upper-extremity control, gait, bowel/bladder function, and sensation. Willingness to pursue implantation showed no correlation with the degree of functional recovery promised by the hypothetical BCI. Likewise, willingness did not correlate with participants' rehabilitative priorities or their level of disability. Discussion: These findings indicate a strong interest in invasive BCIs even when only basic functions may be restored, independent of disability severity or stated priorities. This suggests that first-generation commercial invasive BCIs with limited functionality may still find receptive users. However, stated interest may not translate to informed surgical consent in real-world contexts, thereby highlighting the risk of overly optimistic expectations. Hence, robust, transparent consent frameworks and balanced communication are essential as invasive BCIs move toward clinical deployment.