Parkinson’s disease (PD) causes non-motor symptoms such as cognitive impairments, which can progress to dementia, leading to occupational performance issues. The use of a non-invasive brain-computer interface (BCI) is a promising approach in neurofunctional rehabilitation, such as the application of an upper-limb exoskeleton. Although BCI has been validated for other neurological conditions, further research is needed to investigate its impact as a rehabilitation strategy for individuals with PD, including its effects beyond motor symptoms.

To assess the effects of BCI-controlled exoskeleton use on cognition and occupational performance in individuals with PD.

This pilot study involved 10 daily intervention sessions, each lasting 60 minutes, using BCI with motor imagery combined with an exoskeleton applied to the most affected hand, followed by the execution of the imagined action. Each participant imagined and executed five problem-based activities in the domains of self-care, productivity, and leisure, focusing on tasks they found most challenging. The assessment instruments used before and after the interventions included the Parkinson’s Disease Cognitive Rating Scale (PD-CRS) and the Canadian Occupational Performance Measure (COPM).

A total of 12 individuals with PD participated (6 men and 6 women), with a mean age of 60.41 years. The majority were right-hand dominant (91.6%), with eight participants exhibiting contralateral motor symptoms. The average time since diagnosis was 3.9 years, with most participants classified at stage 3 (58.3%) according to the Hoehn and Yahr Scale. Participants demonstrated significant improvement in subcortical frontal cognitive functions (p = 0.016), including sustained attention, working memory, alternating and verbal action fluency, clock drawing, and immediate and delayed free recall verbal memory; posterior cortical functions (p = 0.001), including confrontation naming and clock copying; as well as in the total PD-CRS score (p = 0.007). Both occupational performance and satisfaction significantly improved (p < 0.001) according to the COPM, with sustained benefits observed in a follow-up assessment after four weeks.

BCI-controlled motor imagery intervention using a robotic glove is a viable approach for individuals with PD, as it significantly improved cognitive functions and participants&apos; perceived performance and satisfaction in daily activities. Further studies, particularly randomized clinical trials with larger sample sizes and long-term interventions, are necessary to determine whether BCI application plays an effective role in PD rehabilitation.

The use of an exoskeleton appears to have positive implications for the functional rehabilitation of individuals with PD. BCI has the potential to enhance neuronal activation, promoting brain reorganization and plasticity, thereby stimulating cognitive functions. A notable aspect of this study is its individualized approach, tailoring imagined and executed activities to each participant’s specific needs while incorporating key neurofunctional rehabilitation principles, including neurofeedback, repetitive training, and treatment intensity.