NANNING, April 11 (Xinhua) -- In March, inside the rehabilitation gym of the First Affiliated Hospital of Guangxi Medical University, a 48-year-old man surnamed Li stood encased in a robotic exoskeleton, a lightweight electrode-studded cap resting on his head. He closed his eyes and formed a single, clear thought: "I want to walk."
Within moments, the gentle purring of motors filled the room. A brain-computer interface (BCI) had decoded his intention. Pulses from a spinal cord stimulator raced down his neck and lower back, calming spasms and reviving dormant neural pathways. The exoskeleton's mechanical braces responded, swinging his left leg forward.
It was the first step he had taken under his own volition since a massive stroke paralyzed the left side of his body in late 2024.
The session represented a clinical milestone for south China's Guangxi Zhuang Autonomous Region: the first deployment of a fully integrated "mind-driven" rehabilitation system that combines a BCI, spinal cord electrical stimulation, and a robotic exoskeleton to aid stroke recovery.
More broadly, the procedure reflects China's accelerating push to move high-tech neuroengineering away from the laboratory and into real-world solutions for a growing public health crisis involving spinal cord injury and stroke.
For Li, the stroke had left him with dense hemiplegia and severe spastic paralysis -- a condition where muscles are permanently stiff, and joints are effectively locked.
In standard stroke therapy, such as massage or acupuncture, the patient is a passive recipient of care as therapists manipulate their rigid limbs in the hope of reawakening some faint muscle memory. But for Li, nearly a year's worth of repetition yielded minimal progress.
Earlier this year, a multi-departmental team led by Feng Daqin, chief surgeon of neurosurgery, decided to flip the script by putting Li back in the driver's seat.
"BCI is not actually a brand-new concept," said Feng. "Even a basic cochlear implant to help restore a patient's hearing is a form of technology. But what we are doing now is moving from a single channel to a genuine, closed-loop interaction."
The system functions as a digital bridge. The electrode cap captured his intent to move. The spinal stimulator calmed the spasms and reopened pathways severed by the stroke. The exoskeleton translated the signal into physical motion while simultaneously feeding the sensation of walking back to his brain.
In the process, thought became pulse, pulse became step, said Feng. And after two weeks of this intensive training, Li could voluntarily lift his arm and flex his knee.
"There is an inherent trade-off in moving from implants to external caps, sacrificing a degree of precision in favor of safety," said Feng. "Yet in this case, the resolution provided by this non-invasive system was more than adequate to meet the clinical needs."
Li's treatment is part of a broader and rapidly expanding effort by Chinese medical institutions to bring BCI technology into routine clinical use.
The year 2025 was widely seen as a breakout year for BCI in China, marked by the opening of new clinics and dedicated wards nationwide, according to Feng. The collaborative team from Huashan Hospital and the Chinese Academy of Sciences launched the country's first invasive BCI trial that same year.
China's National Healthcare Security Administration (NHSA) released a pricing guideline for neural system care services in 2025, specifying brain-computer interfaces (BCIs) as an independent category. The move aims to boost the clinical application of the cutting-edge technology to benefit patients in need.
This year, China's National Medical Products Administration (NMPA) approved an implantable BCI medical device for patients with tetraplegia caused by cervical spinal cord injuries. Jointly developed by Shanghai-based Neuracle Medical Technology and Tsinghua University, the device is the world's first commercially approved invasive brain-computer interface product, marking a shift from clinical application toward real-world deployment.
China's institutions have focused heavily on stroke recovery, driven by a hard truth of demographic reality. Data show that the country has around 26.7 million stroke patients, making it a region with a high incidence and a heavy disease burden of stroke globally.
"The clinical need for stroke patients is far more urgent and vaster than for spinal cord injuries," Feng noted.
According to Feng, the Chinese approach differs from much of the BCI research in Western countries. While many Western projects rely on invasive brain implants that require open surgery, Chinese hospitals have prioritized non-invasive or minimally invasive methods, placing safety and broader accessibility at the forefront.
While leading hospitals like Beijing Tiantan Hospital remain global leaders in invasive BCI research, regional centers like Guangxi are carving out their own niches with hybrid systems.
Feng's team is already looking toward the next frontier: applying BCI technology to other neurological disorders, including Parkinson's disease.
The hospital also sees the BCI technology as a potential conduit for greater cross-border medical cooperation. Located on China's southern frontier, Guangxi is a primary gateway to the ASEAN countries, the country's largest trading partner.
"Currently, there are no reported applications of this integrated technology in ASEAN countries," said Feng. The ambition is clear: the system is meant to be more than a local success but a sophisticated medical export for the region.
For Li, the scientific and strategic implications feel rather distant. Between training sessions, he still relies on a wheelchair. But each day in the gym, he closes his eyes, forms the thought, and takes another step under his own power.
For a man who once believed he might never walk again, that small, deliberate motion has become everything. ■
