Movement-assist devices such as neuromuscular stimula-tion systems can be used to generate movements in people with chronic hand paralysis due to stroke. If de-tectable, motor planning activity in the cortex could be used in real time to trigger a movement-assist device and restore a person’s ability to perform many of the activities of daily living. Additionally, re-coupling motor planning in the cortex with assisted movement generation in the periphery may provide an even greater benefit—strengthening relevant synaptic connections over time to promote natural motor recove-ry. This study examined the potential for using electroencepha-lograms (EEGs) as a means of rapidly detec-ting the intent to open the hand during movement planning in individuals with moderate chronic hand paraly-sis following a subcortical ischemic stroke. On average, attempts to open the hand could be detected from EEGs approximately 100–500 ms prior to the first signs of movement onset. This earlier detection would mi-nimize device activation delays and allow for tighter coupling between initial formation of the motor plan in the cortex and augmentation of that plan in the periphery by a movement-assist device. This tight tempo-ral coupling may be important or even essential for strengthening synaptic connections and enhancing natu-ral motor recovery.

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