JMIR Publications

ABSTRACT

Background:

Motor neuron disease (MND) causes progressive paralysis with preserved cognition. Implantable brain–computer interfaces (iBCIs) may help restore function, but patient priorities and tolerance for associated burdens remain poorly understood.

Objective:

To assess the preferences of people with MND for iBCI functions, performance characteristics, and acceptable surgical and training demands.

Methods:

A cross-sectional online survey was disseminated by the MND Association (30 September–15 December 2024). Thirty-nine adults responded, with 32 completing the survey, reporting demographic and clinical information, iBCI awareness, desired device functions, and tolerable surgical risks and training demands.

Results:

Among participants, 66.7% (n=26) used digital devices during every waking hour, yet 30.8% (n=12) were unable to control them with their hands. Familiarity with BCIs was generally low. Most (80%, n=28) would accept surgical implantation if it offered meaningful benefits, though only 60% (n=21) would do so if its function lasted just one year. Participants tolerated a median of 12 home-based training sessions (versus five if clinic-based), and nearly half preferred sessions under two hours. Mobility, communication, and upper limb function were the most desired iBCI functions. Among digital-specific applications, communication, employment, and leisure emerged as the top three preferences. When considering iBCI implantation, accuracy, ease of use, and long-term reliability were prioritised over speed. More than 90% emphasised the need for ongoing technical support to reduce the risk of device abandonment.

Conclusions:

These findings highlight a strong willingness among people with MND to undergo iBCI surgery if it provides lasting functional improvements with minimal training burden. Enhanced patient education and guaranteed long-term support may be critical for maximising adoption and real-world impact.